Personality Disorders may be the least understood of the various mental disorders considered by Social Security. If you are seeking disability for mental health problems and have a personality disorder listed amongst your mental impairments, it is best to have a skilled disability advocate on your side who understands Personality Disorders and how they are different from other mental impairments which may be very similar in pathology and symptomology.
Social Security’s Listing 12.08 covers Personality Disorders. Social Security says: “These disorders are characterized by enduring, inflexible, maladaptive, and pervasive patterns of behavior. Onset typically occurs in adolescence or young adulthood.” This does reflect an understanding of how personality disorders differ from other mental impairments which may seem similar. As opposed to more acute mental problems which may be readily treatable, Personality Disorders are “enduring, inflexible” and “maladaptive.” These features can make personality disorders very difficult to treat, as clinicians may struggle with the effectiveness of both the psychotropic medications and cognitive behavioral therapy strategies which they most often turn to treat their patients.
Popular usage has led to some of the confusion about personality disorders. For example, calling someone “antisocial” in everyday usage would likely mean someone who would prefer to stay at home as opposed to going out and being around others. However, someone with an “antisocial personality disorder” is violent, dishonest, or otherwise exhibits criminal behaviors, and has little to no concern for others. The “narcissistic personality disorder” label applies to someone who thinks he or she is better than others and takes advantages of others with little remorse, likely due to feelings of entitlement. The label is now so ubiquitously used colloquially that it common usage in may just be a synonym for someone vain and/or inconsiderate, even without the pathological lack of regard for others which is characteristic of the disorder.
The similarity of personality disorders to other mental impairments compounds the confusion. For example, “Cluster A” personality disorders – including paranoid personality disorder and schizotypal personality disorder – sound a lot like schizophrenia. All can involve paranoia and delusional thinking. Hallucinations are seen most frequently in people with schizophrenia but can also occur in someone with a personality disorder like this, likely to a lesser extent.
Cluster B personality disorders include not only the aforementioned narcissistic and antisocial personality disorders, but also borderline personality disorder (BPD), which seems to be the most commonly diagnosed of all. Someone with BPD have a fear of abandonment and/or problems trusting others. Someone with PTSD may experience similar feelings and emotions. Also, someone with BPD may have mood swings which could mimic a bipolar disorder.
Cluster C personality disorders include an avoidant personality disorder, a label which could be applied to someone who does not want to leave the home and instead tends to isolate. We also see this in someone who has anxiety with agoraphobic tendencies. Obsessive Compulsive Disorder (OCD) is also within Cluster C. Someone like this – with an unnatural focus on order, structure, and routine – may share traits with someone who has an Autism Spectrum Disorder.
So, with so much symptom overlap between personality disorders and other mental impairments, it’s important to focus on what makes them different. If your disability representative understands this, it can really help your disability case. In my experience, when a client has been diagnosed with a Personality Disorder it is always one of multiple mental diagnoses. It’s certainly possible to have a sole personality disorder diagnosis, but I haven’t seen it. Perhaps this is because optimistic mental health professionals want to help their patients and understand how limited treatment options can be for someone with a personality disorder. They want to create a diagnostic picture which would show the potential for helpful treatment.
Nonetheless, psychotropic medications intended to change brain chemistry may not necessarily alter the “enduring” and “inflexible” nature of Personality Disorders. For example, something like an SSRI medication (like Fluoxetine or Sertraline) may do little to alter the feelings of emptiness or fear of being abandoned that can trouble someone with BPD. The lack of concern for others affecting someone with a narcissistic or antisocial personality disorder may not be amenable to pharmaceutical treatment either, as there’s no medication which would necessarily fix this. Cognitive behavioral therapy may be effective in some cases, but the very features that led to the personality order diagnosis may limit the benefits of treatment. For example, someone with BPD may not trust the clinician enough to make significant progress and some with avoidant personality disorder may lack the desire to interact with a therapist.
For these reasons, Personality Disorders may be amongst the mental disorders most likely to lead to “enduring” disability that may not improve with treatment. Yet getting the decision maker to see this can be difficult. First, we have the confusion and lack of understanding that’s been described. Even worse, this may be associated with a “sympathy gap” in those who may decide a case. A Social Security decision maker may easily sympathize with a hardworking parent who goes blind and is unable to provide for the family and would likely feel good about making the decision to award this person benefits. It’s a lot different when someone has an antisocial personality disorder and cannot control the impulses that lead to violent or dishonest behavior. Just naturally, a decision maker may be less inclined to assign someone like this with fair limitations which would lead to an equitable finding on whether or not they are disabled. But the best advocates fight for their clients when mental problems they cannot change make them unable to work. No matter the nature of your disability, the attorneys at Keller & Keller will apply their skills and experience to fight for you.
