14.9 Personality Disorders: Going to Extremes

Think for a minute about high school acquaintances whose personalities made them stand out. Was there an odd person who didn’t seem to make sense, wore strange outfits, and sometimes wouldn’t respond in conversation? Or perhaps a drama queen, whose theatrics and exaggerated emotions turned everything into a big deal? And don’t forget the neat freak, who had the perfectly organized locker, precisely arranged hair, and sweater with zero lint balls. One way to describe such people is to say they simply have personalities, the unique patterns of traits we explored in the Personality chapter. But sometimes, personality traits can become so rigid and confining that they blend into mental disorders. Personality disorders are enduring patterns of thinking, feeling, or relating to others or controlling impulses that deviate from cultural expectations and cause distress or impaired functioning. Personality disorders begin in adolescence or early adulthood and are relatively stable over time.

personality disorders

Enduring patterns of thinking, feeling, or relating to others or controlling impulses that deviate from cultural expectations and cause distress or impaired functioning.

The DSM-5 lists 10 specific personality disorders (see TABLE 14.3). They fall into three clusters: (a) odd/eccentric, (b) dramatic/erratic, and (c) anxious/inhibited. The strange high school student, for example, could have schizotypal personality disorder (odd/eccentric cluster); the drama queen could have histrionic personality disorder (dramatic/erratic cluster); the neat freak could have obsessive-compulsive personality disorder (anxious/inhibited cluster). Don’t rush to judgment, however. Most of those kids are probably quite healthy and fall far short of qualifying for a diagnosis. Still, the array of personality disorders suggests that there are multiple ways an individual’s gift of a unique personality could become a problem.

Table : Table 14.3 Clusters of Personality Disorders

Cluster

Personality Disorder

Characteristics

A. Odd/Eccentric

Paranoid

Distrust in others, suspicion that people have sinister motives. Apt to challenge the loyalties of friends and read hostile intentions into others’ actions. Prone to anger and aggressive outbursts but otherwise emotionally cold. Often jealous, guarded, secretive, overly serious.

 

Schizoid

Extreme introversion and withdrawal from relationships. Prefers to be alone, little interest in others. Humorless, distant, often absorbed with own thoughts and feelings, a daydreamer. Fearful of closeness, with poor social skills, often seen as a “loner.”

 

Schizotypal

Peculiar or eccentric manners of speaking or dressing. Strange beliefs. “Magical thinking” such as beliefs in ESP or telepathy. Difficulty forming relationships. May react oddly in conversation, not respond, or talk to self. Speech elaborate and difficult to follow. (Possibly a mild form of schizophrenia.)

B. Dramatic/Erratic

Antisocial

Impoverished moral sense or “conscience.” History of deception, crime, legal problems, impulsive and aggressive or violent behavior. Little emotional empathy or remorse for hurting others. Manipulative, careless, callous. At high risk for substance abuse and alcoholism

 

Borderline

Unstable moods and intense, stormy personal relationships. Frequent mood changes and anger, unpredictable impulses. Self-mutilation or suicidal threats or gestures to get attention or manipulate others. Self-image fluctuation and a tendency to see others as “all good” or “all bad.”

 

Histrionic

Constant attention seeking. Grandiose language, provocative dress, exaggerated illness, all to gain attention. Believes that everyone loves them. Emotional, lively, overly dramatic, enthusiastic, and excessively flirtatious. Shallow and labile emotions. “Onstage.”

 

Narcissistic

Inflated sense of self-importance, absorbed by fantasies of self and success. Exaggerates own achievement, assumes others will recognize they are superior. Good first impressions but poor longer-term relationships. Exploitative of others.

C. Anxious/Inhibited

Avoidant

Socially anxious and uncomfortable unless they are confident of being liked. In contrast with schizoid person, yearns for social contact. Fears criticism and worries about being embarrassed in front of others. Avoids social situations due to fear of rejection.

 

Dependent

Submissive, dependent, requiring excessive approval, reassurance, and advice. Clings to people and fears losing them. Lacking self-confidence. Uncomfortable when alone. May be devastated by end of a close relationship or suicidal if breakup is threatened.

 

Obsessive-compulsive

Conscientious, orderly, perfectionist. Excessive need to do everything “right.” Inflexibly high standards and caution can interfere with their productivity. Fear of errors can make them strict and controlling. Poor expression of emotions. (Not the same as obsessive-compulsive disorder).

Source: Information from American Psychiatric Association, 2013.

Ever browse a copy of Architectural Digest and wonder who would live in one of those perfect homes? A person with obsessive-compulsive personality disorder might fit right in. This personality disorder (characterized by excessive perfectionism) should not be mistaken, by the way, for obsessive-compulsive disorder—the anxiety disorder in which the person suffers from repeated unwanted thoughts or actions.
Getty Images/Image Source

Personality disorders have been a bit controversial for several reasons. First, critics question whether having a problematic personality is really a disorder. Given that approximately 15% of the U.S. population has a personality disorder according to the DSM–5, perhaps it might be better just to admit that a lot of people are difficult and leave it at that. Another question is whether personality problems correspond to “disorders” in that there are distinct types or whether such problems might be better understood as extreme values on trait dimensions such as the Big Five traits discussed in the Personality chapter (Trull & Durrett, 2005). Debate on these questions is ongoing.

One of the most well-studied of all personality disorders—and the one most likely to land someone in jail—is antisocial personality disorder (APD), a pervasive pattern of disregard for and violation of the rights of others that begins in childhood or early adolescence and continues into adulthood. The terms sociopath and psychopath describe people with APD who are especially coldhearted, manipulative, and ruthless—yet may be glib and charming (Cleckley, 1976; Hare, 1998). For example, consider the case of Henri Desiré Landru. In 1914, Landru began using personal ads to attract a woman “interested in matrimony,” and he succeeded in seducing 10 of them. He bilked them of their savings, poisoned them, and cremated them in his stove. He recorded his murders in a notebook and maintained a marriage and a mistress all the while. The gruesome actions of serial killers such as Landru leave us frightened and wondering; however, bullies, compulsive liars, and even drivers who regularly speed through a school zone share the same shocking blindness to human pain. Many people with APD do commit crimes, and many are caught because of the frequency and flagrancy of their infractions. Among 22,790 prisoners in one study, 47% of the men and 21% of the women were diagnosed with APD (Fazel & Danesh, 2002). Statistics such as these support the notion of a “criminal personality.”

antisocial personality disorder (APD)

A pervasive pattern of disregard for and violation of the rights of others that begins in childhood or early adolescence and continues into adulthood.

469

470

What are some of the factors that contribute to APD?

Adults with an APD diagnosis typically have a history of conduct disorder before the age of 15. In adulthood, a diagnosis of APD is given to individuals who show three or more of a set of seven diagnostic signs: illegal behavior, deception, impulsivity, physical aggression, recklessness, irresponsibility, and a lack of remorse for wrongdoing. About 3.6% of the general population has APD, and the rate of occurrence in men is 3 times the rate in women (Grant et al., 2004). Evidence of brain abnormalities in people with APD is also accumulating (Blair, Peschardt, & Mitchell, 2005). For example, criminal psychopaths who are shown negative emotional words such as hate or corpse exhibit less activity in the amygdala and hippocampus than do noncriminals (Kiehl et al., 2001). The two brain areas are involved in the process of fear conditioning (Patrick, Cuthbert, & Lang, 1994), so their relative inactivity suggests that psychopaths are less sensitive to fear than are other people. It might seem peaceful to go through life “without fear,” but perhaps fear is useful in keeping people from the extremes of antisocial behavior.

Henri Desiré Landru (1869–1922) was a serial killer who met widows through newspaper ads. After obtaining enough information to embezzle money from them, he murdered 10 women. He was executed for serial murder in 1922.
Three Lions/Getty Images

SUMMARY QUIZ [14.9]

Question 14.17

1. Which of the following is a common feature of personality disorders?
  1. failure to take other people’s perspectives
  2. excessive fear of rejection
  3. unstable moods
  4. overly dramatic attempts at attention seeking

a.

Question 14.18

2. Jim was diagnosed as having antisocial personality disorder based on the fact that he
  1. is emotionally distant, suspicious of others, and has an intense fear of rejection.
  2. avoids social interaction, has very poor social skills, and is often seen as a “loner.”
  3. is very peculiar in his speech and dress and has difficulty forming relationships.
  4. is manipulative, impulsive, and coldhearted, showing little emotional empathy.

d.