Personality disorder is the current terminology for what we once called character pathology. A personality is the sum total of how we think, feel and behave, and it is the foundation from which we operate both socially and occupationally.
A personality disorder, however, is a developmental defect. It disrupts how a patient deals with relationships, life’s demands and how the patient perceives and reacts to stressors.
There are groups (called clusters) of personality disorders that represent the severity of this developmental defect. On the one extreme you may have a dependent personality disorder in which the individual is unable to deal independently with life and defers even minor decisions to others, continually seeking approval. On the other extreme are disorders such as paranoid personality disorder in which the individual lives a life of continual distrust of the motives of others. Suspicious and guarded, these latter individuals are watchful for even the slightest signs of betrayal.
About 10 percent of the population may have symptoms and signs of a personality disorder. It is generally believed that personality disorders are much more prevalent among injured workers, and, indeed, that the personality disorder may lead the person to a line of work in which injury is more probable. In either case, we are often dealing with a developmentally compulsive or negativistic or avoidant or even a chaotic individual. The injury did not cause this, but the personality disorder will definitely complicate the treatment of the patient.
Thus, it is imperative that we determine when a patient is responding inappropriately due to the co-existence (“co-morbid”) personality disorder. We cannot change that disorder, but we can then base even orthopedic treatment upon the limitations imposed by the disorder.