Mental disabilities impact thinking, emotional state, and behaviour, and affect psychological functioning. Physical disabilities are obvious to the person and others and often attract cooperation, kindness, and help. In contrast, mental disabilities, especially personality disorders, may not be obvious to themselves or others, and when noticed, attract scorn and avoidance. Mental disabilities are of three types: Intellectual disability (neurodevelopmental disorder), Learning disability, and Mental (psychiatric) disorder. Mental disorders may be personality, anxiety, mood, substance abuse, or psychotic disorder. Personality disorders involve disruptive thinking, behaviour, mood, social interaction, and communication. Approximately 6% of the global population has a personality disorder. Personality disorders are difficult to treat in psychiatry, as those afflicted don’t seek treatment, as they don’t accept that their behaviour is problematic. Seniors and leaders with personality disorders can be a serious problem to others and can ruin families, institutions, and nations.
TYPES OF PERSONALITY DISORDERS: There are 10 types of recognized personality disorders, grouped in three main clusters, each with a different symptom set. Cluster A includes Paranoid, Schizoid, and Schizotypal personality disorders. These individuals have unusual and eccentric thinking or behaviours and are “treatment-resisting.” The paranoid mistrust and suspect others of trying to demean, harm, or threaten them. The schizoid are detached, unemotional, and disinterested in interpersonal relationships. The schizotypal have superstitions, distorted views of reality, and unusual behaviours, limiting close relationships. Cluster B includes Antisocial, Borderline, Histrionic, and Narcissistic personality disorders. They display intense, unstable emotions and impulsive, dramatic, and erratic behaviours, and are “treatment-ignorant”. Cluster C includes Avoidant, Dependent, and Obsessive-compulsive personality disorders. They have severe anxiety and fear and are “treatment-seeking”. Obsessive-compulsive personality disorder (OCPD) is distinct from the anxiety disorder obsessive-compulsive disorder (OCD). While people with OCD are usually aware of their mal-behaviour and accept they need to change, people with OCPD have little, if any, self-awareness of their behaviours. Antisocial personality disorders are more likely to affect males. Borderline, histrionic, and dependent personality disorders are more likely to affect females. A malfunctioning gene that may be a factor in obsessive-compulsive personality disorder and subtle brain changes in paranoid and schizotypal personality disorders have been identified. Childhood traumas and abuse may be linked to borderline and antisocial personality disorders. Children who suffered verbal abuse are three times more likely to have borderline, narcissistic, obsessive-compulsive, or paranoid personality disorders in adulthood, as per one study. Cultural factors are also important, as antisocial personality disorder rates are lower, but cluster C personality disorder rates are higher in Taiwan, China, and Japan.
DANGEROUS PERSONALITY DISORDERS: Cluster B personality disorders, i.e., Antisocial Personality Disorder (APD), Borderline Personality Disorder (BPD), and Narcissistic Personality Disorder (NPD), are considered dangerous to themselves, others, and society. They create a toxic work environment characterized by fear, intimidation, and a lack of accountability. APD is the most dangerous, characterized by a disregard for social norms, a lack of empathy, and a tendency to manipulate or exploit others for personal gain. Individuals with APD may engage in unethical or violent behaviour, and they often lack remorse for their actions. APD affects 2 to 4 percent of the population, but affects up to 47 percent of male prison inmates and 21 percent of female prison inmates, as per a WebMD report. BPD is marked by intense emotional instability, impulsivity, and difficulty with relationships. Individuals with BPD may experience significant mood swings, engage in self-harm or suicidal behaviour, and struggle with maintaining healthy relationships. NPD individuals have an exaggerated sense of self-importance, a need for admiration, a disregard for others, and a tendency to exploit them for personal gain. They may be manipulative, insensitive, and unwilling to take responsibility for their actions. Many successful leaders may have personality traits that are strengths in certain critical situations, but their disordered behaviours affect their leadership, the rest of the time.
ANXIETY DISORDERS: These are mental health conditions that cause disproportionate fear or dread, uncontrollable, obsessive thoughts, and difficulty concentrating, interfering with one’s ability to function. Approximately 25 percent of the U.S. population has been reported to suffer from one of these disorders. They are twice as likely to affect women. There are several types, including generalized anxiety disorder, panic attacks, specific phobias, and social anxiety disorder. Post-traumatic stress disorder (PTSD), acute stress disorder, and obsessive-compulsive disorder (OCD) are distinct conditions with similar symptoms. Some anxiety can be beneficial if it helps us notice and focus on staying safe in dangerous situations. Treatment is effective, and usually includes relaxation techniques, medication, and psychotherapy.
INSECURITY: Though insecurity, or a lack of self-assurance, is not a personality disorder, it can be a symptom of borderline personality disorder (BPD), avoidant personality disorder, and even narcissistic personality disorder. Insecurity can stem from various factors, including childhood experiences, sibling rivalry, genetics, and learned behaviours. Insecure individuals may seek excessive validation from others, avoid potentially embarrassing situations, have difficulty trusting others, are jealous or possessive in relationships, and are prone to bullying. To deal with your insecurities, focus on building self-esteem, challenging negative thoughts, and practicing self-compassion. Embrace a growth mindset, focus on your strengths, and set achievable goals. Limit social media consumption and seek support from trusted friends, family, or a therapist if needed. To effectively deal with someone who consistently overreacts, prioritize active listening, focus on validating their feelings while setting boundaries, and manage your emotional response. Do not be dismissive or critical; instead, focus on building trust, understanding their perspective, and gently redirecting their negativity. Key strategies include patience, empathy, clear communication, and knowing when to step away. Dealing with the insecurities of competitors involves understanding the psychology behind their behaviour and focusing on your strengths and strategies rather than on their perceived weaknesses. Insecure leaders can negatively impact their teams and organizations through various consequences, including decreased productivity, toxic work environments, and a lack of trust and collaboration. Their need for validation, fear of failure, and tendency to micromanage can lead to stifled creativity, demotivated employees, and a decline in overall performance.
INTERMITTENT EXPLOSIVE DISORDER (IED): An “anger personality” refers to those with a fragile ego, frequently experiencing and expressing anger, easily irritated by minor inconveniences or disagreements, having difficulty expressing anger constructively, and with a tendency to blame others for problems rather than focusing on solutions. IED is an episodic mental health problem and is not considered a personality disorder. It is characterized by recurrent episodes of failure to control aggressive impulses, leading to verbal outbursts, serious assault, or property destruction. These episodes can include temper tantrums, physical fights, property damage, domestic violence, or road rage. Minor frustrations or perceived slights trigger the outbursts. The reactions are significantly more intense than the situation warrants. After the outbursts, individuals with IED may feel remorseful or guilty. It can lead to significant distress, relationship problems, occupational difficulties, and legal issues. It typically begins in adolescence and can affect people of all ages, but it’s more common in males. It can co-occur with Cluster B personality disorders (like Borderline, Antisocial, Narcissistic, and Histrionic) due to shared traits like impulsivity and aggression. Cognitive-behavioural therapy (CBT) and other therapies can help individuals identify triggers, develop coping mechanisms, and manage anger. Relaxation techniques like deep breathing or mindfulness can help individuals calm down during an episode. Medications, such as antidepressants or mood stabilizers, may be needed.
HUBRIS SYNDROME: Hubris Syndrome is a temporary psychological state or a pattern of behaviour where leaders with prolonged success and minimal constraints lack humility, display excessive pride, overconfidence, recklessness, disregard for consequences, and a diminished sense of reality, often leading to poor decision-making based on flawed assumptions. They are unaware of their weaknesses or blind spots, unwilling to accept criticism or consider alternative viewpoints. Hubris syndrome is an example of the Peter Principle, in a hierarchy, individuals tend to be promoted to a level where they are incompetent, and the Parkinson’s Law that work expands to fill the available time, basically inaction. Neville Chamberlain’s policy of appeasement towards Hitler, despite warnings from advisors, is often cited as an example of hubris syndrome. Many well-known world political, business, religious leaders, and historical figures have grievously harmed their nations, institutions, and communities with faulty decisions or negligence, and sometimes started a catastrophic war.
Personality disorders are complex and require professional diagnosis. It’s not appropriate to diagnose individuals based on observed behaviours alone. Many individuals with personality disorders struggle to recognize their behaviour as problematic, blame external factors or others as the cause of their problems. This can make it difficult for them to seek help or engage in treatment. Psychotherapy, such as cognitive behavioural therapy (CBT) or psychodynamic therapy, can help address the underlying issues. With appropriate treatment, individuals with personality disorders can develop strategies to manage their symptoms and improve their interpersonal skills.
Dr. P.S.Venkatesh Rao is a Consultant Endocrine, Breast & Laparoscopic Surgeon, Bengaluru.