Personality Disorders, Traits and Styles: Real or Imagined; Temporary or Enduring
(Emma Pivato, 2005)
We are all shaped by our genetics, our history and by the random circumstances which impact us throughout our lives. Accordingly, we can become friendly and open or watchful and guarded, generous and trusting or mean and suspicious, relaxed and easy going or driven and competitive – or any thing in between. When do these traits become a problem to the extent that they interfere, all or in part, with adaptive functioning and when are they just a unique part of whom we are?
In this paper I will first outline the main characteristics of the ten personality disorders described in DSM-IV-TR and discuss how and why they are clustered as they are. Then, I will review the dimensions of personality styles described in the Myers-Briggs model.
Finally, I will ask what it all means.
PERSONALITY DISORDERS
DSM-IV divides personality disorders into three fairly distinct clusters based on social alienation, excessive emotionality and fearfulness. These disorders serve to either push the afflicted individual away from others because of their own fears and suspicions or to push others away from them because of their maladaptive patterns of interacting. Individuals with such disorders can appear less afflicted at certain points in their lives, for example when they are young and many options appear open to them and the future seems hopeful, and more afflicted at other points, for example, when they are under a lot of stress or there is further personality breakdown because of their inability to cope with another personality on a close daily basis as in marriage.
Cluster A personality disorders include paranoid, schizoid and schizo-affective. Like all the other personality disorders traits can appear in children and adolescents because of role modeling on parents. For this and other reasons, diagnosing the presence of a personality disorder in individuals under 18 is ethically questionable.
Paranoid Personality Disorder is characterized by a pervasive distrust and suspiciousness of others. Individuals with this disorder are preoccupied with doubts that others are out to cheat them or undermine them in some way and they therefore act in a very secretive and self-protective way. When they are, inadvertently or otherwise, hurt or offended by somebody they persistently bear grudges. Spouses are regarded with chronic suspicion of infidelity or other wrongdoing. Sooner or later this style of interacting undermines most or all of their relationships with others.
Schizoid Personality Disorder is characterized by minimal desire for social interactions with others and a very flat, narrow range of emotion in terms of what social interactions are experienced. Individuals with this order are likely to have particular difficulty expressing anger and their lives may seem rather directionless. It is quite often a precursor to schizophrenia, and is found more often in the families of individuals with schizophrenia or Schizotypal Personality Disorder than in the general population. Culture-shock, the ‘freezing’ that can occur after an individual is transplanted from one ethnic context to another or from a rural to an urban setting, may appear similar in nature but is generally temporary in nature.
Schizotypal Personality Disorder is the most obviously odd of the Cluster A personality disorders but not nearly as likely to lead to Schizophrenia as Schizoid Personality Disorder. Individuals with this disorder present as acutely uncomfortable in social situations and remarkably inept at even the most mundane social intercourse. They also have cognitive and perceptual distortions such as circumstantial speech and magical thinking and they often tend to be very suspicious and to have paranoid ideation. Because of this they are anxious in social situations and do not become less anxious as the social event progresses. Although there is a modest increase in Schizophrenia and other psychotic disorders in the relatives of individuals with Schizotypal Personality Disorder it tends to be a relatively stable condition that rarely deteriorates into any form of psychosis.
Cluster B Personality Disorders are characterized by the emotional and the unpredictable. There is a chasm between themselves and others which they cannot cross because of their lack of empathy. This is perhaps most blatant in individuals with Antisocial Personality Disorder but it occurs in the other three disorders in this Cluster as well: Borderline, Histrionic and Narcissistic.
Individuals with Antisocial Personality Disorder were in the past referred to as Psychopaths or Sociopaths. Their presentation is now characterized as personality disorder rather than character flaw and the terminology has changed accordingly.
At the centre of this disorder is a generalized disregard for and violation of the rights of others. Three or more of the following elements are also present: a disregard for social norms leading to illegal behavior; deceitfulness; irritability and aggressiveness; impulsivity; consistent irresponsibility and lack of remorse. This pattern emerges as conduct disorder early in life, before age 15. The disorder itself cannot be diagnosed before the age of 18.
Borderline Personality Disorder has attracted a lot of attention in recent years because these individuals end up in mental health settings in disproportionate numbers and are extremely resistant to treatment. People with this disorder (75% female) often experience identity disturbance. That is to say, they do not really know who they are or want to be and can rapidly shift persona from needy to champion of the needy, from meek and mild to defiant and brave, depending on their context. They, in fact, need a highly structured context around them to know who they are and do best in highly defined work and home situations. Impulsivity and self-mutilating behavior are often present and represent their frantic attempts to escape their always lurking sense of emptiness, aloneness and abandonment. Of all the personality disorders this one can come closer to a psychotic state than any other, hence the name. Under sufficient stress they readily decompensate becoming irrational and even further removed from a clear and integrated sense of personal identity, i.e. dissociating and experiencing paranoid ideation. They can become intensely angry very quickly and without any apparent just cause. Personal relationships are intense and unstable, marked by extremes of idealization and devaluation. Today’s idol can be cast down in the dirt tomorrow because of a careless word or minor thoughtless act which is perceived as a direct personal attack. Instability and impulsivity is at its peak in the 20’s. In their 30’s and 40’s, and after treatment, more than half will fail to meet full criteria for Borderline Personality Disorder although some traits persist throughout their lifetime.
Histrionic Personality Disorder is primarily characterized by excessive emotionality. There is a great and unabating need to be the centre of attention and such individuals are overly concerned about impressing others, spending inordinate amounts of time and money on clothes and accessories and being sexually provocative in a variety of inappropriate contexts. Although Borderline Personality Disorder can also be characterized by attention seeking, manipulative behavior and rapidly shifting emotions, it is distinguished from Histrionic Personality Disorder by the presence of self-destructiveness, angry disruptions in close relationships, and chronic feelings of deep emptiness and identity disturbance. Many of the characteristics of Histrionic Personality Disorder are also found in individuals with Antisocial Personality Disorder, e.g. a tendency to be impulsive, superficial, excitement seeking, reckless, seductive, and manipulative, but individuals with Histrionic Personality Disorder are more exaggerated in their emotions and do not characteristically engage in antisocial behaviors. They are manipulative to gain nurturance, whereas those with Antisocial Personality Disorder are manipulative to gain profit or power at the expense of another.
Narcissistic Personality Disorder has at its centre feelings of superiority, need for admiration and lack of empathy. Like individuals with Histrionic Personality Disorder these people crave attention but the difference is that in this attention they want praise for their superiority while the individual with Histrionic Personality Disorder just wants attention, even if to get it he or she must appear fragile or dependent, i.e. in a one down position. Since individuals with Narcissistic Personality Disorder believe they are superior they don’t want attention from, or for that matter to associate with, just anyone. They want to surround themselves with other people who are special or who are perceived as having high social status. They often attribute special qualities to those with whom they do associate such as giftedness. This enhances (mirrors) their own self-esteem. These are the individuals who insist on being served by the top person or professional in an agency. They expect to be catered to and are puzzled or even angry when their needs are not recognized as special and deserving of immediate attention. In contrast, they have great difficulty recognizing the needs and aspirations of others, assuming that those with whom they are in association are gratified just by having the opportunity to meet a special person’s needs, i.e. their own.
The sense of superiority of these individuals tends to be very vulnerable; hence the phrase that has arisen in recent years, ‘fragile narcissist’.
Although they may not show it outwardly, criticism may haunt these
individuals and may leave them feeling humiliated, degraded, hollow
and empty. They may react with disdain, rage or defiant counterattack.
(DSM-IV-TR, p. 716)
The last resonates with another phrase that we have heard increasingly in recent times: ‘malignant narcissist’. These people perceive that any slight or criticism is personal and malicious and they don’t just get mad. They get even. Like individuals with Antisocial Personality Disorder they tend to be superficial, exploitative and lacking in empathy. However, they are not usually deceitful or aggressive, at least not without what they perceive to be just cause, as described above.
Cluster C Personality Disorders group together individuals who often appear anxious or fearful. Three separate disorders have been identified in this cluster. Avoidant Personality Disorder involves a pattern of social inhibition, deep-rooted feelings of inadequacy and gross oversensitivity to criticism as well as hyper-vigilance to avoid it at almost any cost. These individuals minimize risk taking, avoiding groups and forming close relationships only when they are absolutely sure of acceptance, which means basically that the other party has to bend over backwards to assure them. Their extreme social inhibition severely limits both social and occupational opportunities but the need for closeness is still there so they may latch on fiercely to the few relationships they do have, presenting as quite needy and dependent in the process.
Dependent Personality Disorder is fundamentally characterized by an everlasting need to be supported and taken care of and is marked by submissive and clinging behavior. These individuals tend to be passive and unable to make even simple decisions such as what to wear on a given day. They give away most of their power to others, often to a single person, in return for ongoing nurturing and guidance. These individuals tend to be plagued by pessimism and self-doubt and this is the personality disorder most frequently encountered in mental health clinics. Like individuals with Avoidant Personality Disorder they fear rejection more than anything but instead of withdrawing they actively seek out others for support and guidance.
Obsessive-Compulsive Personality Disorder is characterized by a preoccupation with order, perfection and control to the extent that it grossly interferes with efficiency, productivity and normal social intercourse. There is painstaking attention to rules and rituals in a never-ending, and never succeeding, effort to meet this high standard. Individuals with this disorder may also be excessively rigid and scrupulous about matters of morality to the point where they arereluctant to delegate tasks or to work with others,believing that their way is the only right way. They tend to be miserly and stingy with themselves and others and in general are characterized by their rigidity and stubbornness.
The demographic information available to date suggests that roughly 10% of the general population could be labeled as having one or more of the personality disorders described above. In the light of this information let us now consider the development of the Myers-Briggs Type Indicator and the rationale underlying it.
The Myers-Briggs was inspired by the type theory of Carl Gustav Jung which first appeared in English under the title, Psychological Types, in 1923. In it he posited the existence of three different types of individuals:
1. extrovert (needing people) vs. introvert (craving solitude)
2. feeling type vs. thinking type (different values)
3. intuitive (imaginative) vs. sensing (looks only at what is)
Jung, however,never fully developed his system and basically abandoned it. He maintained throughout his life that people are dynamic, not static, and cannot be reduced to a few unchanging, one-dimensional categories.
Jung’s post-publication disenchantment with his system of types was not known to Katherine Briggs, however. Katherine led a relatively sheltered life outside of academia. She had been home-schooled until she attended university at age 14 or 16 (depending on the source). After she married she stayed home to raise her only child, a daughter, Isabel. The three of them, including her husband, Lyman, a well-respected and well connected physicist and researcher, were very close. Isabel went off to Swarthmore College at age 18 and it was a shock to her parents when she came home two years later with the man she was to marry, Clarence (“Chief”) Myers. The Briggs were all quite similar in their sensibilities: imaginative and intuitive, but Chief was quite different. An aspiring lawyer, he was practical and logical in his outlook.
It was in her effort to understand Chief, and to find a way to include him fully and without reservation in her family, that Katherine began developing her theory of types. To this end she did much reading of biographies and of psychology and philosophy books. She had the basics of a theory worked out when she came upon Carl Jung’s Psychological Types. She found it to be a very similar system to hers but more highly developed and she was so impressed by his categorization that she threw out her own system and embraced his system wholeheartedly, applying it without reservation to an analysis of her now expanded family. All four of them were introverts but the two men were thinkers and the two women feelers. The three Briggs were ‘intuitives’ while Chief Myers was a ‘senser’.
Isabel graduated first in her class at SwathmoreCollegebut then, like her mother, stayed home to raise her children, Peter and Ann. She did write a mystery novel using type theory as the key to finding out who the killer was and in 1942, when her children were teenagers, she saw a Reader’s Digest article about a new people-sorting instrument, the Humm-Wadsworth Temperament Scale. This instrument had been designed to fit workers to the most appropriate jobs, thereby keeping them happy and at the same time increasing productivity.
People-sorters were early personality tests which began appearing in the 1910’s, and were designed to meet the needs of business. There was much that was flimsy or outright fraudulent in these tests and when Isabel thoroughly examined the Humm she found it was not as impressive as it first sounded. Her mother suggested that she write her own test and the Myers-Briggs was on its way.
Isabel was at this point a 44 year old housewife with no training in psychology, no knowledge of test construction, no lab, no funding, not even a university affiliation.
However, she did have an excellent mind, basic university training, and a strong support system in her parents and husband. They were to provide the bulk of the financial and moral support as well as much of the expertise she needed to bring her project to fruition. She learned statistics and psychometrics on her own with the help of books borrowed from the public library but also received assistance from her father in those areas when needed. Lyman told the Dean of George Washington University about Isabel’s work and he was sufficiently impressed that he allowed her to administer her test prototype to the entire class of first year medical students. Through this and other testing opportunities that became available to her, Isabel acquired much data and feedback. She became increasingly preoccupied with processing the data, absorbing and integrating the feedback and refining her instrument and gradually withdrew her primary interest from her family. Her husband complained that she no longer had time to even go to a movie with him.
Extensions and alterations of the Jungian model:
To Jung’s original three pairs of opposites Isabel added a fourth axis: judging vs. perceiving. Also, Myers’ focus was on healthy persons, not the mentally ill individuals who had concerned Jung.