By: THEODORE MILLON
et al.
In the last two
decades, the study of personality and its disorders has become central to the study of abnormal
psychology.
The word personality is derived from the Latin term
persona, originally representing the theatrical mask used by
ancient dramatic players. Today, personality is seen as a complex pattern of
deeply embedded psychological characteristics that are expressed automatically
in almost every area of psychological functioning. That is, personality is
viewed as the patterning
of characteristics across the entire matrix of the person. Personality is often
confused with two related terms, character and temperament. Character refers to characteristics acquired during
our upbringing and connotes a degree of conformity
to virtuous social standards. Temperament, in contrast, refers not to the
forces of socialization,
but to a basic biological disposition toward certain behaviors. Understanding personality
disorders requires an understanding of their role in the study of abnormal behavior. Diagnostic criteria are the defining
characteristics used
by clinicians to
classify individuals within a clinical category. Each disorder has
its own unique list. In
general, the list of criteria for the personality disorders runs either seven, eight, or nine
items, each of which details some characteristic trait, attitude, or behavior
strongly related to that particular disorder. A personality trait is a long-standing pattern of behavior expressed across
time and in many different situations. Where many such personality traits
typically occur together, they may be said to constitute a personality disorder. When all of these
characteristics are taken together,
they constitute a personality prototype.
The mental
disorders in the DSM
are
grouped in terms of the multi-axial model. Each axis represents a
different kind or source of information. The multi-axial model exists because some means is required whereby the
various symptoms and personality characteristics of a given patient can be brought
together to paint a picture that reflects the functioning of the whole
person. The multi-axial model is divided into five separate axes, each of which gets at a
different source or level of influence in human behavior. Axis II, the personality
disorders, provides both a substrate and context for understanding the symptoms
of Axis I. Every personality style is also a coping style, and personality is a cardinal
organizing principle through which psychopathology should be understood.
Normality and
abnormality cannot be distinguished on a completely objective basis. Normality and pathology usually reside on a continuum.
Personality disorders do seem to be characterized by
three pathological characteristics. First, personality disorders tend to exhibit a tenuous
stability, or lack of resilience, under conditions of stress. Second, personality-disordered subjects are adaptively
inflexible. Disordered personalities create vicious cycles by
repeating their pathology again and again.
In personality,
the dominant perspectives are psychodynamic, biological, interpersonal, and
cognitive. Biological influences on personality may be thought of as being either proximal or distal. Distal influences originate
within our genetic code and often concern inherited characteristics transmitted as part
of the evolutionary history of our own species. Other biological influences in
personality focus on proximal causes, influences that exist because we are
complex biological systems. When the structures that underlie behavior differ,
behavior itself is affected. Two such concepts important to personality are
constitution and temperament.
The word temperament came into the English language
in the Middle Ages to reflect
the biological soil from
which personality develops. Temperament is an underlying biological potential
for behavior, seen most clearly in the predominant mood or emotionality of an
individual and in the intensity of his or her activity cycles. As such, it
refers to the
sum total of inherited biological influences on personality that show
continuity across
the life span. Because our physical matrix exists before other domains of
personality emerge, biologically built-in behavioral tendencies preempt and
exclude other possible pathways of development that might take hold. Constitution refers to the total plan or philosophy on which something is constructed. The
foremost early exponent of the constitutional approach was Ernst Kretschmer (1926),
who developed a classification system based on three main body types—thin, muscular,
and obese—each of which was associated with certain personality traits and
psychopathologies.
More recently,
neurobiological models have been proposed by Cloninger (1986, 1987b), as well as by Siever and Davis (1991).
Cloninger’s model is based on the interrelationship of three
genetic-neurobiologic trait dispositions, each of which is associated
with a particular
neurotransmitter system: dopaminergic, serotonergic, or noradrenergic.
Each is hypothesized to
dispose the individual toward a different type of behavioral tendency. Siever and Davis
suggest a psychobiological model consisting of four dimensions cognitive/perceptual
organization, impulsivity/aggression, affective instability, and anxiety/inhibition—each of
which has both Axis I and Axis II manifestations.
The most distal
influence in personality is genetics. Researchers explore the influence of genes
on behavior by searching for the presence of similar psychopathologies in siblings and relatives of an afflicted subject, by
studying patterns of transmission across generations of the extended family, and by
comparing the correlation of scores obtained on personality tests between sets of
fraternal twins and identical twins reared together and apart. The
evidence for a genetic influence on personality is strongest for antisocial and schizotypal
personality disorders. Other evidence suggests that the paranoid and schizoid
personality disorders may be linked genetically with schizophrenia.
A popular genetic
hypothesis is that the wild emotional swings of the borderline personality are
evidence of its association with the affective disorders, which include
depression and manic-depression.
Of all the
classical perspectives on personality, the psychoanalytic is perhaps the most conceptually rich.
Sigmund Freud, the father of psychoanalysis, was born in 1856. Freud’s first theory of
neuroses emerged from his work with hypnosis and referred to the idea that behind every
neurotic conflict lies a forgotten childhood trauma. The memories
of that trauma are said
to be repressed.
Motivated
to forget what it knows, the mind defends against the painful experiences by
actively excluding them from conscious awareness. Eventually, Freud elaborated
his insights into the topographic model, the idea that the mind has an organization
or architecture that overflows consciousness and can be described in terms of
different levels or compartments: the unconscious, the preconscious, and conscious awareness. Later, Freud developed a
structural model of the mind constituted by the id, consisting of the basic
survival instincts and drives; the ego, which develops to mediate between the
demands of the id and the constraints of external reality; and the superego, which
represents the internalized social values of caretakers. The id works on the basis of the pleasure principle, whereas the ego works on the reality principle. Breaking moral codes results
in feelings of guilt, while satisfying the ego ideal results in feelings of pride and self-respect. For
Freud, personality is seen as a war of attrition fought by three generals. As
the executive branch of the personality, the ego must balance and mediate between
constraints on all sides. On the one hand, the id, upwelling from below, is always
percolating, yearning for gratification. On the other hand, the prohibitions of
the superego prevent its desires from being directly satisfied.
The workings of
the id, ego, and superego produce different types of anxiety, which is a signal to the ego that something must be done. In
time, Freud and his disciples discovered the defense mechanisms. Although every individual uses
a variety of defenses, each personality disorder seems to prefer a particular
subset of defense over the
others. These can be
used to construct a defensive profile that illustrates how that personality
disorder protects itself from internal and external sources of anxiety, stress,
and challenge.
According to
Freud, personality develops through a series of five psychosexual stages. Over the course of normal maturation, each
psychosexual stage naturally gives way to the next, presenting the
individual with a sequence of maturational challenges. In the psychodynamic perspective,
character has a technical meaning, referring to the way in which the ego habitually
satisfies the demands of the id, superego, and environment. Since the study of personality
begins with the psychodynamic study of character, many of the personality disorders
have direct characterological counterparts. As later analytic writers became interested in
the relationship among character, defense, interpersonal conduct, and cognitive style,
the relationship between character and personality has grown even stronger.
The final stage
in the development of the psychodynamic perspective is called object relations. Every instinct has an aim and
an object. The aim is always the satisfaction of instinctual desires. The
object is something in the outside world through which this aim can be achieved. For Freud,
the id instincts formed the basis of human nature. In contrast, modern object relations
theory is simultaneously cognitive and interpersonal, emphasizing first, that the
outside world is known through mental representations or internal working
models, and second, that the contents of these models are interpersonal,
being developed largely
during early childhood from experiences with caretakers and significant others, prior even
to the development of self-awareness. The foremost object relations thinker in the
personality disorders is Kernberg, who advocates classifying various personalities,
some from the DSM and some from the psychoanalytic tradition, in terms of three levels of structural
organization—psychotic, borderline, and neurotic— which represent degrees of
organization or cohesiveness in the personality.
References
Personality
Disorders in Modern Life, second edition, 2000, 2004 by John Wiley & Sons,
Inc.
Read Also
Development of Personality DisordersAssessment and Therapy of the personality Disorders
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