The 10 Personality Disorders

A short, sharp look into the 10 personality disorders.

Neel Burton -Psychology today- Posted May 29, 2012

Source: Pixabay

The study of human personality or "character" (from the Greek charaktêr,

the mark impressed upon a coin) dates back at least to antiquity. In
his Characters, Tyrtamus (371-287 B.C.) — nicknamed Theophrastus or
"divinely speaking" by his contemporary Aristotle — divided the people of
4th century B.C. Athens into 30 different personality types, including
"arrogance," "irony," and "boastfulness." Characters exerted a strong
influence on subsequent studies of human personality, such as those of
Thomas Overbury (1581-1613) in England and Jean de la Bruyère (1645-
1696) in France.

The concept of personality disorder itself is much more recent and

tentatively dates back to psychiatrist Philippe Pinel’s 1801 description
of manie sans délire, a condition which he characterized as outbursts of
rage and violence (manie) in the absence of any symptoms of psychosis,
such as delusions and hallucinations (délires).

Across the English Channel, physician JC Prichard (1786-1848) coined

the term "moral insanity" in 1835 to refer to a larger group of people who
were characterized by "morbid perversion of the natural feelings,
affections, inclinations, temper, habits, moral dispositions and natural
impulses," but the term, probably considered too broad and non-specific,
soon fell into disuse.

Some 60 years later, in 1896, psychiatrist Emil Kraepelin (1856-1926)

described seven forms of antisocial behavior under the umbrella of
"psychopathic personality," a term later broadened by Kraepelin’s younger
colleague Kurt Schneider (1887-1967) to include those who "suffer from
their abnormality."

Schneider’s seminal volume of 1923, Die psychopathischen

Persönlichkeiten(Psychopathic Personalities), still forms the basis of
current classifications of personality disorders, such as those contained in
the influential American classification of mental disorders, the Diagnostic
and Statistical Manual of Mental Disorders 5th Revision (DSM-5).

According to DSM-5, a personality disorder can be diagnosed if there are

significant impairments in self and interpersonal functioning together with
one or more pathological personality traits. In addition, these features
must be (1) relatively stable across time and consistent across situations,
(2) not better understood as normative for the individual’s developmental
stage or socio-cultural environment, and (3) not solely due to the direct
effects of a substance or general medical condition.

The DSM-5 lists 10 personality disorders and allocates each to one of

three groups or "clusters": A, B, or C.

Cluster A (Odd, bizarre, eccentric)

 Paranoid PD
 Schizoid PD
 Schizotypal PD
Cluster B (Dramatic, erratic)

 Antisocial PD
 Borderline PD
 Histrionic PD
 Narcissistic PD
Cluster C (Anxious, fearful)

 Avoidant PD
 Dependent PD
 Obsessive-compulsive PD
Before going on to characterize these 10 personality disorders, it should
be emphasized that they are more the product of historical observation
than of scientific study, and thus that they are rather vague and imprecise
constructs. As a result, they rarely present in their classic "textbook" form,
but instead tend to blur into one another. Their division into three clusters
in DSM-5 is intended to reflect this tendency, with any given personality
disorder most likely to blur with other personality disorders within its
cluster. For instance, in cluster A, paranoid personality is most likely to
blur with schizoid personality disorder and schizotypal personality
disorder.

The majority of people with a personality disorder never come into contact
with mental health services, and those who do usually do so in the
context of another mental disorder or at a time of crisis, commonly after
self-harming or breaking the law. Nevertheless, personality disorders are
important to health professionals, because they predispose to mental
disorder and affect the presentation and management of existing mental
disorders. They also result in considerable distress and impairment, and
so may need to be treated "in their own right." Whether this ought to be
the remit of the health professions is a matter of debate and controversy,
especially with regard to those personality disorders which predispose
to criminal activity, and which are often treated with the primary purpose
of preventing crime.

. Paranoid personality disorder

Cluster A is comprised of paranoid, schizoid, and schizotypal personality
disorders. Paranoid personality disorder is characterized by a pervasive
distrust of others, including even friends, family, and partners. As a result,
this person is guarded, suspicious, and constantly on the lookout for clues
or suggestions to validate his fears. He also has a strong sense of
personal rights: He is overly sensitive to setbacks and rebuffs, easily feels
shame and humiliation, and persistently bears grudges. Unsurprisingly,
he tends to withdraw from others and to struggle with building close
relationships. The principal ego defense in paranoid PD is projection,
which involves attributing one’s unacceptable thoughts and feelings to
other people. A large, long-term twin study found that paranoid PD is
modestly heritable, and that it shares a portion of its genetic and
environmental risk factors with schizoid PD and schizotypal PD.

2. Schizoid personality disorder

The term "schizoid" designates a natural tendency to

direct attention toward one’s inner life and away from the external world.
A person with schizoid PD is detached and aloof and prone to
introspection and fantasy. He has no desire for social or sexual
relationships, is indifferent to others and to social norms and conventions,
and lacks emotional response. A competing theory about people with
schizoid PD is that they are in fact highly sensitive with a rich inner life:
They experience a deep longing for intimacy, but find initiating and
maintaining close relationships too difficult or distressing, and so retreat
into their inner world. People with schizoid PD rarely present to medical
attention, because despite their reluctance to form close relationships,
they are generally well functioning and quite untroubled by their apparent
oddness.

3. Schizotypal disorder

Schizotypal PD is characterized by oddities of appearance, behavior, and

speech, unusual perceptual experiences, and anomalies of thinking
similar to those seen in schizophrenia. These latter can include odd
beliefs, magical thinking (for instance, thinking that speaking of the devil
can make him appear), suspiciousness, and obsessive ruminations.
People with schizotypal PD often fear social interaction and think of
others as harmful. This may lead them to develop so-called ideas of
reference — that is, beliefs or intuitions that events and happenings are
somehow related to them. So whereas people with schizotypal PD and
people with schizoid PD both avoid social interaction, with the former it is
because they fear others, whereas with the latter it is because they have
no desire to interact with others or find interacting with others too difficult.
People with schizotypal PD have a higher than average probability of
developing schizophrenia, and the condition used to be called "latent
schizophrenia."

4. Antisocial personality disorder

Cluster B is comprised of antisocial, borderline, histrionic, and narcissistic

personality disorders. Until psychiatrist Kurt Schneider (1887-1967)
broadened the concept of personality disorder to include those who
"suffer from their abnormality," personality disorder was more or less
synonymous with antisocial personality disorder. Antisocial PD is much
more common in men than in women and is characterized by a callous
unconcern for the feelings of others. The person disregards social rules
and obligations, is irritable and aggressive, acts impulsively, lacks guilt,
and fails to learn from experience. In many cases, he has no difficulty
finding relationships — and can even appear superficially charming (the
so-called "charming psychopath") — but these relationships are usually
fiery, turbulent, and short-lived. As antisocial PD is the mental disorder
most closely correlated with crime, he is likely to have a criminal record or
a history of being in and out of prison.

5. Borderline personality disorder

In borderline PD (or emotionally unstable PD), the person essentially

lacks a sense of self and, as a result, experiences feelings of emptiness
and fears of abandonment. There is a pattern of intense but unstable
relationships, emotional instability, outbursts of anger and violence
(especially in response to criticism), and impulsive
behavior. Suicidal threats and acts of self-harmare common, for which
reason many people with borderline PD frequently come to medical
attention. Borderline PD was so called, because it was thought to lie on
the "borderline" between neurotic (anxiety) disorders and psychotic
disorders, such as schizophrenia and bipolar disorder. It has been
suggested that borderline personality disorder often results from
childhood sexual abuse, and that it is more common in women, in part
because women are more likely to suffer sexual abuse. However,
feminists have argued that borderline PD is more common in women,
because women presenting with angry and promiscuous behavior tend to
be labeled with it, whereas men presenting with similar behaviour tend
instead to be labeled with antisocial PD.

6. Histrionic personality disorder

People with histrionic PD lack a sense of self-worth and depend on

attracting the attention and approval of others for their wellbeing. They
often seem to be dramatizing or "playing a part" in a bid to be heard and
seen. Indeed, "histrionic" derives from the Latin histrionicus, "pertaining to
the actor." People with histrionic PD may take great care of their
appearance and behave in a manner that is overly charming or
inappropriately seductive. As they crave excitement and act on impulse or
suggestion, they can place themselves at risk of accident or exploitation.
Their dealings with others often seem insincere or superficial, which in the
longer term can adversely impact their social and romantic relationships.
This is especially distressing to them, as they are sensitive to criticism
and rejection and react badly to loss or failure. A vicious circle may take
hold in which the more rejected they feel, the more histrionic they become
— and the more histrionic they become, the more rejected they feel. It
can be argued that a vicious circle of some kind is at the heart of every
personality disorder and, indeed, every mental disorder.

7. Narcissistic personality disorder

In narcissistic PD, the person has an extreme feeling of self-importance, a

sense of entitlement, and a need to be admired. He is envious of others
and expects them to be the same of him. He lacks empathy and readily
lies and exploits others to achieve his aims. To others, he may seem self-
absorbed, controlling, intolerant, selfish, or insensitive. If he feels
obstructed or ridiculed, he can fly into a fit of destructive anger and
revenge. Such a reaction is sometimes called "narcissistic rage" and can
have disastrous consequences for all those involved.

8. Avoidant personality disorder

Cluster C is comprised of avoidant, dependent, and anankastic

personality disorders. People with avoidant PD believe that they are
socially inept, unappealing, or inferior, and constantly fear being
embarrassed, criticized, or rejected. They avoid meeting others unless
they are certain of being liked and are restrained even in their intimate
relationships. Avoidant PD is strongly associated with anxiety disorders,
and may also be associated with actual or felt rejection by parents or
peers in childhood. Research suggests that people with avoidant PD
excessively monitor internal reactions, both their own and those of others,
which prevents them from engaging naturally or fluently in social
situations. A vicious circle takes hold in which the more they monitor their
internal reactions, the more inept they feel; and the more inept they feel,
the more they monitor their internal reactions.

9. Dependent personality disorder

Dependent PD is characterized by a lack of self-confidence and an

excessive need to be looked after. This person needs a lot of help in
making everyday decisions and surrenders important life decisions to the
care of others. He greatly fears abandonment and may go through
considerable lengths to secure and maintain relationships. A person with
dependent PD sees himself as inadequate and helpless, and so
surrenders his personal responsibility and submits himself to one or more
protective others. He imagines that he is at one with these protective
other(s), whom he idealizes as competent and powerful, and towards
whom he behaves in a manner that is ingratiating and self-effacing.
People with dependent PD often end up with people with a cluster B
personality disorder, who feed on the unconditional high regard in which
they are held. Overall, people with dependent PD maintain a naïve and
child-like perspective and have limited insight into themselves and others.
This entrenches their dependency, leaving them vulnerable to abuse and
exploitation.

10. Anankastic (obsessive-compulsive) personality disorder

Anankastic PD is characterized by an excessive preoccupation with

details, rules, lists, order, organization, or schedules; perfectionism so
extreme that it prevents a task from being completed; and devotion to
work and productivity at the expense of leisure and relationships. A
person with anankastic PD is typically doubting and cautious, rigid and
controlling, humorless, and miserly. His underlying anxiety arises from a
perceived lack of control over a world that eludes his understanding, and
the more he tries to exert control, the more out of control he feels. As
a consequence, he has little tolerance for complexity or nuance, and
tends to simplify the world by seeing things as either all good or all bad.
His relationships with colleagues, friends, and family are often strained by
the unreasonable and inflexible demands that he makes upon them.

Closing remarks

While personality disorders may differ from mental disorders, like

schizophrenia and bipolar disorder, they do, by definition, lead to
significant impairment. They are estimated to affect about 10 percent of
people, although this figure ultimately depends on where clinicians draw
the line between a "normal" personality and one that leads to significant
impairment. Characterizing the 10 personality disorders is difficult, but
diagnosing them reliably is even more so. For instance, how far from the
norm must personality traits deviate before they can be counted as
disordered? How significant is "significant impairment"? And how is
"impairment" to be defined?

Whatever the answers to these questions, they are bound to include a

large part of subjectivity. Personal dislike, prejudice, or a clash of values
can all play a part in arriving at a diagnosis of personality disorder, and it
has been argued that the diagnosis amounts to little more than a
convenient label for undesirables and social deviants.

Adapted from the new second edition of The Meaning of Madness (2015).
Neel Burton is also author of Hypersanity: Thinking Beyond
Thinking, Heaven and Hell: The Psychology of the Emotions, and Hide
and Seek: The Psychology of Self-Deception.

Plato's Allegory of the Cave

And why it is still relevant today.
Posted Jun 29, 2019
Plato's Allegory of the Cave by Jan Saenredam, according to Cornelis van Haarlem, 1604
Source: Wikicommons

The allegory of the cave (circa 380 BCE)

Human beings spend all their lives in an underground cave with its mouth
open towards the light. They have their legs and necks shackled so that
they can only see in front of them, towards the back of the cave. Above
and behind them, a fire is blazing. Between them and the fire is a low wall
behind which men carry diverse statues above their heads, and the fire
casts the shadows of these statues onto the back of the cave. Because
the shadows are all they ever see, the prisoners suppose that the
shadows are the objects themselves.

If a prisoner is unshackled and turned towards the light, he suffers sharp

pains, but in time begins to discern the statues. He is then dragged out of
the cave, where the light is so bright that he can only look at the shadows,
and then at the reflections, and then finally at the objects themselves, of
which the statues were but pale imitations. In time, he looks up at the sun,
and understands that the sun is the cause of everything that he sees
around him, of light, of sight, and the objects of sight.
The purpose of education is to drag the prisoner as far out of the cave as
possible; not merely to instill knowledge into his soul, but to turn his whole
soul towards the sun, which is the "Form of the Good."

Once outside, the prisoner is reluctant to go back into the cave and
involve himself in human affairs. When he does, his vision is no longer
accustomed to the dark, and he appears ridiculous to his fellow
men. Nonetheless, he must be made to go back down and partake of
human labors and honors, because the State aims at the happiness not of
a single person or class but of all its citizens. What’s more, the freed
prisoner has a duty to give service to the State, since it was by the State
that he was educated to see the light of the sun.

Quoting from Book VII of the Republic:

The State in which the rulers are most reluctant to govern is always
the best and most quietly governed, and the State in which they are
most eager, the worst... You must contrive for your future rulers
another and a better life than that of a ruler, and then you may have
a well ordered State; for only in the State which offers this, will they
rule who are truly rich, not in silver and gold, but in virtue
and wisdom, which are the true blessings of life... And the only life
which looks down upon the life of political ambition is that of
true philosophy. Do you know of any other?

Discussion

What if we are being radically deceived? What if I am no more than a

brain kept alive in a vat and fed with stimuli by a mad scientist? What if
my life is nothing but a dream or computer simulation? Like the prisoners
in Plato’s cave, I would be experiencing not reality itself, but a mere
facsimile or simulacrum of reality. I could not be said to know anything at
all, not even that I was being deceived.

Which would you prefer: a life of limitless pleasure as a brain in a vat or a

genuine, human life along with all its struggle and suffering? Most
people actually opt for the latter, suggesting that we value truth and
authenticity and, by extension, that we value knowledge for its own sake,
as well as for its instrumentality.
But, as I argue in my new book, even if we are not being radically
deceived, it is not at all clear that we can have any knowledge of the
world. Much of our everyday knowledge comes from the use of our
senses, especially sight. "Seeing is believing," as the saying goes. But
appearances, as we all know, can be deceptive: A stick held under water
appears to bend; and hot tarmac, when viewed from a distance, looks like
sparkling water. Our senses are subject to manipulation, as, for example,
when a garden designer uses focal points or clever planting to create an
illusion of space. My mind interprets a certain wavelength as the color
red, but another animal or even another person may interpret it as
something entirely other, or perhaps not perceive it at all. A bat or a
salmon experiences the world very differently to me. And what about
you? How do I know that what I experience as pain is also what you
experience as pain? You may react as I do, but that need not mean that
you are minded like I am, or even that you are minded at all. All I might
know is how the world appears to me, not how the world actually is.

But according to Plato, if we care enough about the truth, or are made to
care, we may be able to apprehend the true nature of reality, by the
use, not of our limited senses, but of our free-ranging reason and intellect.
This ever-broadening perspective qualifies us to rule, but is so
captivating, so bright and blissful, that we are unwilling to do so—
preferring instead to hide out in our cozy libraries and lush gardens. And
yet we must stoop down, dirty our hands, and expose ourselves to the
public glare, because, as Plato says, the penalty for refusing to rule is to
be ruled by someone worse than yourself.

See my related post, "What is Truth?"

References

Plato, Republic, Bk VII, 514a–520a. Translated by Benjamin Jowett.