Personality Disorder and Personality Traits

First and foremost a diagnosis of a disorder means illness, and dysfunction. Mental health has best been described first by Freud and later adapted by the WHO as roughly, the ability love, work and play.
We consider a person's ability to love by the quantity and quality of relationships.  A person might have many 'superficial' 'short term' relationships best described as acquaintances without any long term deeper relationships, better described as friends. It is unlikely that at any time a person has so many deep and personal relationships as they do acquaintances.
This friendship pattern and the years of relationships and how a person's voice changes in the mentioning of friends is indicative of the nature and depth of relationships.  Psychopaths may describe relationships without a tonal differentiation which can deeply reflect the depth of the relationships.  A patient with Aspergers may similarly lack the ability to indicate emotionally the difference between their mother's name and the person who they just met today.
Dr. C. Jung did research on significance of delays in response but similarly one of the cues emotionally to the 'meaningfulness' of relationships is in the non verbal communication which simply tells a sensitive examiner that a person's reference to a friend is a 'felt' friendship and not merely an 'acquaintance' relationship.
The love life of an individual starts with family and how a person speaks of family is inherent in the nature of the communication given when one asks about family and family history.  Some people maintain long term positive relationships with family members indicating healthy maintenance of relationship compared to those who have not seen or communicated with a parent in decades. The latter indicates all manner of potential area of conflict and/or deficit.
After family relationships, friendships begin in school era, and hometowns then progress to workplace and associated institutions such as church and club and recreational associations.
Finally the length and depth of primary relationships is an indication of presence or absence of disorder.
People who have maintained relationships with family, have friends and acquaintances, can name them and speak about them, and those who have maintained intimate relationships for 5 years or longer have clearly a highly developed personality regarding the 'capacity' to form and maintain relationships. I say '5' years for the latter because our 'western society' has been described as 'serial monogamy' with a 50% divorce rate and average length of relationship at 5 years.
Clearly in a previous generation the role of the marriage was a more significant indicator of personality development but considering an arranged marriage with limited choice for alternatives this might well reflect societal development over individual development.  The greater the 'free choice' the greater the development of a trait since, as with morality, lack of opportunity for vice, doesn't necessarily reflect "virtue'.  Virtue requires the potential for 'test'.  Similarly an isolated individual might well not have the opportunity to make friends whereas a person in a healthy community's isolation might well reflect intrinsic deficits.
A disorder of relationships is not only seen with personality disorder but is at it's worst with thought disorder (e.g. schizophrenia) and mood disorders (e.g. bipolar, depression).
The ability to work and maintain work reflects a person of strong personality because the character traits of survival and success are related intimately to work. This is reflected first in schooling, the higher the education, the greater the learning, the greater the diversity and buffering and the greater the successful network.  A university education is like a 'white collar' or 'officer class' development whereas a trade school or skills specific learning may be likened to a 'blue collar' or sergeant class development relative to society or military hierarchies. The success of an individual may reflect to a large degree his family of origins wealth and privilege, the area of community they are from and their associations.  The advantages and disadvantages sociologically and geographically are well documented.
Cultural factors are intrinsically an important aspect of diagnosing and understanding a personality disorder.  One example I recall from practice was an obsessive compulsive upper class asian psychiatrist describing a Jamaican reggae star as having a 'personality disorder'. The Jamaican millionaire's later highly accentuated description of my colleague left me in doubt as to who most like had the personality disorder but clearly understanding that the cultural values of each individual differed by work and place of origen.
As for play one considers diversity of activities. Does one merely 'watch' an event or are they a higher developed 'participant' in sports,arts, or social and recreational communities.  Fat academics don't notice the higher development of a person who coaches and participates in community hockey for instance but will think a 'wine connoisseur' is somehow 'refined' and 'tasteful'.
One is considered to have a 'disorder' when ones' educations, work, and social life and relational world are below an arbitrary standard set roughly for a similar person of similar background and age and culture.  A ghetto child who achieves the first Phd in their family is more 'successful' than a Bachelor of Social Work from a family of PhD's in classics and mathematics.  Though both have achieved an educational development it must be considered in 'context' of the individual family and community.
Naturally everyone wants to 'dumb' down 'classifications and the KISS , "keep it simple, stupid" competes with the KISS, "keep it stupid, simpleton" proponents.
Obviously classical music is beyond the ken of the average country and western musician or rapper just as quantum physics is beyond the ken of the average or even above average arts student.
The traits of personality are in all of us.  All of us have antisocial traits, grandiose traits, narcissistic traits, dependent traits, paranoid traits, obsessive compulsive traits and histrionic traits etc.  The absence of the traits at particular developmental stages is the indication of a more serious disorder than the presence. Traits are also seen to be in balance.  A trait is further 'contextual'.
To understand this is to reflect on the person who 'talks shop' at a part, clearly 'overly dependent on rationality' and 'lacking in capacity for emotionality and relaxation and 'fun', as opposed to the opposite 'workplace 'jokester' who can't 'settle down' and 'pay attention' in the workplace and disrupts the serious flow of work. One's a party pooper and old before their years while the other is immature and disruptive.
The presence of personality traits in excess however is indicative of a disorder. Hence a person who is narcissistic in their workplace ( a leader apparently in war does best if they don't share their inner doubt and fear and resists waffling) but may be very loving in the home.  The American Generals I've met had good friends and  were considered good friends. Hitler, obviously a severely disturbed personality in the area of eugenics, had a powerful friendship network, and  was admirable as a leader before the war and at times quite brilliant in other areas as well as maintaining a love relationship with Eva Brawn for much longer than most North Americans can sustain sexual relationships today.  Prime Minister Mackenzie King, long thought an excellent Canadian leader, frequented prostitutes, held seances to speak with his dead mother and had most peculiar relationship with his dog, Spot.  I don't think it would be right, by mental health standards, to describe him as 'disordered' but I have colleagues who wish to walk on the snow shoes of their betters, so claim that Jesus was Manic Depressive and a masochist and that PresidentGeorge Bush was a narcissistic personality disorder or that President Clinton was a histrionic personality disorder.  To this I respond, some of colleagues are 'nut bars'.
Most great individuals, despite the criticisms found in excellent texts like Paul Johnson's "Intellectuals', would not be called 'personality disorders' even though Marx for one had  distinctly narcissistic traits and St. Paul could well be described as having greater than normal obsessive compulsive traits.
The personality disorders of the DSM - the classification of the American Psychiatric Association - are derived from Carl Jung's classification of personality as Cluster A - Odd , Cluster B - extrovert and Cluster C - introvert.
Personality is developed in late teen years, though Thomas and Chess saw that the temperament of children as calm, or irritable or in between could be seen in infancies.  Over the years the 'context' of the environment in which a personality exists will cause their personality be 'compensated' so that an introvert who gets a job as a television host might well appear an extrovert in later years though actually prefer solitude and quiet time outside of work situations and vice versa for an extrovert who works in an introverted area of endeavour.  Odd individuals left alone will accentuate their differences but when involved in a community the association will polish these diamonds in the rough.
We might call a judge 'narcissistic ' or a psychiatrist 'paranoid' but neither would necessarily have a 'disorder' as these statements may reflect a situational context.  As stated earlier the burden of abnormality must itself be 'abnormal' and their outcome cause significant clinical difficulties for the individual or society and be a long standing 'pattern' of behaviour.  Freud indeed said 'maybe the paranoids were right' when he was escaping Germany because of the Nazi's. Obviously a judge whose interested in 'pleasing everyone' as the histrionic would be, couldn't possibly maintain a 'moral compass' apparently important in such a position where 'objectivity' is demanded by 'justice'.
If a person's personality is 'successful' in that it progresses the individual through life in the main stream of their community then something 'changes' dramatically so that a person's behaviour is 'out of the norm' for that individual, one considers that possibly situational events have impacted on the individual, such as a change in personality from drugs and alcohol or medical disease, such as a brain tumor, or social events, such as war or poverty which might require a wholly different 'adaptive' stately.  Adaptive diversity is what' personality' is also about, its a collection of 'coping strategies' which have 'worked' to date and began to work in adolescence.
 The antisocial personality disorder might have been a bully physically in high school who continued on as a bully through excessive litigation and abuse of women and co workers so that they might overtly succeed' in work, play and relationships overall, for a time. But if they are a 'disorder' versus having 'trait's then these early coping strategies won't carry them well in more complex situations which come with maturity.
A person without  a full blown 'disorder' per se' may nonetheless be described as 'narcissistic' and 'manipulative'.  They might even be 'pathological liars' but not be considered a 'personality disorder' because clearly some work and relationships succeed with lies versus 'text book truth'.  I might not think well of a tobacco executive for instance, the lowest of scum in my opinion frankly, worse than rapists, whores, pedophiles and thieves, but I can't say that a tobacco company executive has a 'personality disorder, he's obviously 'successful' in work, love and play - assuming his golf handicap is adequate - but in my mind, his characterological deficits are strongly 'anti social'.  In contrast a petty thief in and out of jail is clearly an 'anti social personality disorder'.

Now there are those who consider anyone 'different' from them and 'not politically correct' by their standards as being 'ill' or disordered.  In an earlier era these defilers would have called someone a 'goat fucker' but today due to political correctness and deceit,they attempt to use less 'delicious' terminology by 'pseudoscienfically pigeonholing people they don't approve of. To say a person is a personality disorder in this day and era is to perhaps imply that they are a goat fucker but in a 'nice way'.  The poet ee cummings made much fun of those people who described these people thus.  Inclusivity and exclusivity is a central facet of a society where the leadership is 'generous' or 'not generous' as a reflection of whether you're 'useful' or 'not'.  It's a bit of a 'paranoid' analysis. You are either 'with us' or agin us, a 'team player or not'.  To be 'acceptable in England you had to have an Eton accent, in French society, a Parisian accent.
In India there were the 'untouchables' and the jobs associated with them. The gypsies of Europe carried a stigma, as once the gays and blacks and their activities carried a stigma.  A white 'cotton picker' was unlikely to be invited to the local southern country club for instance especially in the 19th century.  Today even as Mandella is being buried the Africans are insisting that the blacker one's skin colour the more African (inside, top of the heap) one is.  Clearly a white man is 'personality disordered' by the new leadership standards, i.e. he's the new goat fucker.
The attempt at the development of a diagnosis of personality disorder and 'traits' was to be as objective scientifically as possible. There is a variety of 'personality' assessment tools.  These are developed from a variety of ways of looking at personality.  There is a complex sophisticated qualitative and quantitatively multi dimensional personality inventory favoured by Europeans and researchers and likely superior in many ways to the DSM working system.  It's a bit like the 'miles' versus 'km' debate.  Despite a lot of lobbying this complicated system wasn't accepted for the latest DSMV which continued to use the 'traditional' Axis II approach. As an older clinician whose studied personality disorder extensively I was frankly thankful because I know the present system backwards and am glad to let the next DSM come of age in the understanding of personality and change and disorder as modern research  is changing.
Character and personality are multidimensional and change over time with core features usually constant.  Yet even a group of 'psychopaths' ,  (psychopaths being thought to absolutely lack a capacity for empathy unteachable and incapable of learning) appeared in their late 50's or early 60's to change in the relationship with a strong maternal loving constant in their lives.  Various theories about 're parenting' and 'holding environments' were developed for these 'exceptions'. New theories are even being required to incorporate understanding of 'spontaneous remissions' which are being discussed in terms of 'quantum change' research.
In contrast' countless studies going back to Kohut and Kernberg and Masterson have shown that Borderline Personality Disorders can be 'cured' in a combination of group and individual therapy. Cameron et al have studied extensively the cost effective and scientific evidence based outcomes of various psychotherapies relative to diagnosis. While few psychologists were trained in the 'curative' treatment of Borderline Personality Disorder, psychiatric psychoanalytic therapy  maintained 'public payment' for this 'evidence based therapy'.  A noted psychologist recommends treatment for borderline personality disorder that have long been established by solid evidence based research as wholly ineffective but are interestingly exorbitantly and exclusively expensive.
Alternatively 'group therapies' have been found by psychologists and psychiatrists alike to 'cure'  borderline personality disorder when combined with standardized individual therapies.  12 step support groups have had high success with borderline personality disorders because of the group holding environment and tolerance for deviation. Indeed many previously diagnosed with a personality disorder who abstain from chemical addiction have a 'spontaneous' cure' of their 'concurrent diagnosis' of personality disorder. As addiction psychiatry has long demonstrated, remove the on going chemical brain damage, and the true personality, not the 'disorder' shines forth.
Similiarly the Elizabeth Fry society has provided 'community' based treatments that have succeeded with antisocial individuals where many psychologists would be 'ignorant' of the success of these modalities while known to sociologists and psychiatric psychotherapists.
A presentation of the successes of the 'community based treatment' modalities developed first in New York for the worst of the marginal,  homeless and drug addicted personality disordered was a major topic at the International Society of Addiction Medicine.  In face of the high cost of individual psychological therapy modalities for this poorly responsive often non compliant group, the community models were being adopted internationally not only because of their clinical success but mostly these days, their cost effectiveness coupled with their high outcome success.
Unfortunately, 'give a little boy a hammer and everything is a nail' couples with everything that isn't a nail, isn't interesting to a little boy with a hammer.  Personality disorders don't respond to 'medication treatment' so are by nature the 'bane' of the reductionist psychopharmacologist psychiatrist.  Indeed the 'cluster b' personality disorders are commonly excluded or actively discriminated against by 'individual psychologists' or by psychopharmacologists psychiatrists' because they don't respond to "their' treatments".  That they respond extremely well to personality disorder specific treatments is widely ignored.
A colleague who was captured by the Pol Pot made an interesting observation of the schizophrenics during his ordeal.  "They didn't get shot.  The Communists withheld food and the schizophrenics were happy to work for food so they didn't get shot like the doctors, lawyers and professors. I followed their lead or I'd have been shot….I think this is a key to understanding why the cluster a 'trait' survive in our society".  What this brilliant cultural psychiatrist, today, was referring to ,was the genetic research work which shows a trait apparently counterproductive is maintained in society because of it's benefit in aberrant situations.  The sickle cell anemia genetic trait is thought to be maintained in a community because it 'protects' against falciparum malaria'.
Similiarly 'antisocial personality disorder' traits are often what make successful soldiers and the 'protectiveness' of borderline personality disorder 'mothers' is what is commonly described in stories of 'mothers' who defend their children against wild animals and  terrorists. In quieter days in better times these same people are often called 'rebells without a cause'.
To understand personality disorder fully one must appreciate that most of those who are 'successful by today's society's standards' would not have been successful a hundred years ago and may not be successful in a hundred years.  Histrionic traits might well be successful in media dominated America but to date hasn't been a particularly successful survival trait in obsessive compulsive paranoid communist China, if one speaks generally.
Whereas schizophrenia appears present in 1% of individuals regardless of culture, country, or political regimen, personality disorders are defined as 'coping' and coping is affected by sociological, psychological and biological and even spiritual factors  which fluctuate by country and culture.  Cluster C individuals are more likely to succeed in traditional Japanese society whereas Cluster B individuals succeed more freely in Los Angeles or New York.  There are even divisions to be made by gender with 75% of antisocial personality disorders being male whereas 75% of borderline personality disorders are female.  Further rural and urban communities differ in regards to areas where a person might more likely be diagnosed a 'personality disorder' as opposed to an eccentric if they were 'cluster a'.  Cluster A personalities generally do more poorly in the city , despite their creativity and uniqueness, but often thrive as 'eccentrics' in the country and especially Britain. Older cultures, as opposed to new cultures like the Canadian frontier, appreciate more wisely the contribution of the eccentrics like Turing.
Of course, stupidity trumps personality every day and very stupid people have been saying all manner of offensive and inconsiderate and downright stupid things about personality and character, reflecting by their statements their own lack of character. The more a person is a 'media personality' the less 'character' they might indeed have as superficial consumer societies dominated by power and money tend to be the least diverse and lack all depth.
They tend to view 'difference' which is what 'personality and character traits' is all about as abnormal and wrong. The more primitive a society the more demand for conformity.  Indeed in the most primitive society decisions are made according to power and all discussion is simply to support the a priori decision.
The arrogance of the ignorant is never to be underestimated because they commonly solve arguments about quantum physics, theology and psychiatry with guns.  Might is right in their realm.  That said, they are frequently wrong, even when they do their best to rewrite history and populate the world with people just like them.  Yes, men , to their negativity.
When a society is anthropological limited to development by the 'strong man' , pre democracy state, then every on is by nature their' bitch'.  Anyone who has true 'character' is a 'threat'.  In Shakespeare, only the 'fool' or 'jester 'is allowed to tell the truth in court which might explain the rise of Comedy today.  King Lear ends with him saying, 'we'll talk of courtly things, whose in, whose out."    Only the 'fool' can tell the truth, which is why the cluster b 'histrionics' and the cluster a  'odd' may well have have have survived considering the above genetic hypothesis. .
Personality is about character and character is about successful 'coping'.  That said, tools to assess personality however have not been able to separate high class call girls , from successful business women and lawyers.  An artist like Joni Mitchell, one of the greatest genius of music and words, would not be considered as successful financially as a stripper singer marketing millions in music as oral pornography. In this case 'all art is sales' is only offensive to those who question the financial system and consumer context of society which equates the death of a baby as a 'fixed' dollar value.  These aspects of 'success' are probably not the realm of 'personality' and 'character analysis' in the context of a 'materialistic' society who argue that success is solely defined by "those with the most toys when they die 'wins'.  What really is the different between love and lust?
Given the limitations of traditional psychology in face of modern research the American Society for education of psychiatrists requires residents be trained in 'spirituality' and the British Society of Psychiatry has a speciality 'division' for ''Psychiatry and Spirituality'.  Apparently when the reductionists threw out the bath water they lost the baby and everyone is now scampering to find this lost infant.
Perhaps that's why reflecting on Personality and Personality Disorder on Christmas Eve isn't so difficulty.