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When You Can't See Your Own Illness

Personality disorders can be ego-syntonic, blinding some to their own condition.

Key points

  • A personality disorder is a mental illness in which you have trouble perceiving and relating to situations and people, including yourself.
  • Many people who are diagnosed with one of the 10 distinct personality disorders in the DSM cannot easily see their own illness.
  • The term "ego-syntonic" is often used to describe personality disorders because they seem normal and acceptable to those experiencing them.
  • "Ego-dystonic" means that you feel like something is off. People with anxiety and depression are aware, often painfully so, of their problems.
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Since the earliest days of human history, we have practiced ways of categorizing and grouping friends, family, and strangers. We might agree that a person is nice, attractive, talented, and funny, while another person is mean, uncaring, aggressive, and lazy. But when do any of these categories become problematic to the point of being a disorder?

This is Who You Are

Ego-dystonic is a psychoanalytic term describing impulses, needs, or thoughts that are unacceptable or repugnant to the ego or self. In other words, something does not feel right with you and you are aware of this. You might wake up one morning feeling anxious or depressed. You carry this feeling with you during the day, wishing it goes away and hoping no one can sense your inner emotional state.

Ego-syntonic, on the other hand, means that your preferences, desires, impulses, and behavior are consistent with your ego. Most personality disorders are considered ego-syntonic because they do not conflict with your sense of identity. They are woven into the very fabric of your identity and you may have a hard time seeing why they are problematic. For example, people with narcissistic personality disorder do not say to themselves, "I feel super narcissistic today and I am longing for this to go away." It is part of you and you see yourself as normal, or even better than normal.

Personality Disorders and Daily Living

A personality disorder (PD) is a type of mental illness in which you have trouble perceiving and relating to situations and to people—including yourself. In general, having a personality disorder means you have a rigid and unhealthy pattern of thinking and behaving no matter the situation. This can lead to significant problems and limitations in relationships, social encounters, work, and school. In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seems natural to you, and you may blame others for the challenges you face.

Specific Categories of Personality Disorders

The Diagnostic and Statistical Manual of Mental Disorders, DSM-5, identifies 10 unique personality disorders, each belonging to one of three groups known as "clusters." Cluster A contains paranoid, schizoid, and schizotypal disorders. In cluster B, one will find borderline, narcissistic, histrionic, and antisocial disorders. In cluster C, the DSM outlines diagnostic criteria for avoidant, dependent, and obsessive-compulsive personality disorders.

    Cluster A: Odd and Eccentric

    The disorders in cluster A often result in social withdrawal, tenseness, irritability, and a lack of emotion. One of the best-known in this cluster is paranoid personality disorder. Psychosis is not usually seen here, but research shows there is a genetic association with schizophrenia.

    Cluster B: Emotional and Dramatic

    Cluster B, also known as the "wild" category contains four disorders. These disorders show a genetic association with mood disorders and substance abuse. One of the most common of these is narcissistic personality disorder (NPD). In addition to other symptoms, those with NPD are more likely than non-narcissists to have personal experiences with mate poaching (romantically attracting someone else’s partner). Mate poachers answer "yes" to questions like, “Have you ever tried to attract someone who was already in a romantic relationship with someone else for a short-term sexual relationship with you?”

    Cluster C: Anxious or Fearful

    The "worried" group, cluster C, contains disorders associated with anxiety (e.g., generalized anxiety disorder, panic disorder, phobias, etc.). Among those who suffer from avoidant personality disorder, for example, the fear of being criticized is often so great they will isolate themselves from the social world.

    What if I or someone I know is in crisis?

    If you are thinking about harming yourself, or know someone who is:

    • Call your doctor.
    • Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
    • Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or TTY: 1-800-799-4TTY (4889) to talk to a trained counselor.
    • If you are in a crisis, make sure you are not left alone. If someone else is in a crisis, make sure he or she is not left alone.

    To find a therapist near you, visit the Psychology Today Therapy Directory

    ©2022 Kevin Bennett, Ph.D. All rights reserved.

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