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Personality Disorders (information)
5 years ago
This Journal is a followup to the previous one about how to find happiness or achieve well-being in life, which mentioned that it has been shown by multiple studies, including the longest running study, that "Good relationships keep us happier and healthier".
IMHO, if you are going to have healthy, positive, nourishing relationships, you need to be able to identify and then either avoid or be able to cope with people who have psychological problems. So to be able to do well at one of the most important things for personal well-being someone needs to know some amateur psychology.
(This may be particularly important for people who are Introverted Intuitive Thinkers (INT's in Jungian type talk) who tend to have difficulty 'reading' and relating to others. Yes, that's me, I'm either INTJ or INTP.)
Since this Journal is going to be about psychology, which is a 'soft' science, I wanted to include a few caveats/disclaimers in advance so that it would be less likely that someone would 'attack' the Journal, my thinking, or myself on these issues. Psychological 'problems' tend to be put in categories which are given names so that they can be discussed but they are mostly rather ill-defined concepts [like lots of things in the soft/social sciences] and some are probably the combination of tens or hundreds or thousands or hundreds of thousands of factors [a combination of multiple factors or dimensions, like many things in the soft/social sciences], all of which exist on a continuum [like most everything in the soft/social sciences, where nothing is black and white and everything is in degrees or shades of gray], and experts can debate, disagree, and/or have conflicting theories and opinions [like lots of things in the soft/social sciences] which may be controversial [and probably are] and only qualified experts can offer expert opinions or diagnoses. The fact that I'm sufficiently concerned/defensive about being 'attacked' just for trying to discuss a 'soft' science topic that I'd bother to write this paragraph is an indication of one or more of my problems. [Specifically, my dysfunctional family dislikes discussing psychology as it might pertain to a family member and uses these and other statements as defense, denial, lecturing and accusation to shut down the discussion.]
There are lots of possible psychological problems, so focusing on the ones that a person is most likely to encounter and that are insidious or potentially difficult to identify and require special behaviors/tactics to deal with (other than just telling them to go to a mental health professional). In particular it is especially helpful to be able to identify and avoid people with Personality Disorders. Estimates vary but ~9-15% of the population has one or more disorder, so this is not a negligible issue (for comparison, the WHO estimates ~5% of the world population suffers from alcohol use disorders and ~18% are heavy episodic drinkers, while according to the CDC ~7% of the US adult population reported heavy alcohol use and ~16% reported binge drinking, so the issue about as prevalent as alcohol abuse). Among the potential psychological problems someone may encounter, the Personality Disorders (PD's) are particularly problematic because they're long term and ego-syntonic (i.e. someone with a PD usually does not think they have a problem or have any motivation to change). Whereas someone with anxiety or depression or post-traumatic stress disorder (PTSD), for instance, generally recognizes they have a problem and would be glad to change if there was an easy way to do so. The PD's also don't involve externally visible signs (like pills or bottles) or tend to get progressively worse over time like substance abuse does, making them potentially somewhat more insidious if you don't know how to spot or deal with them. It is also very easy for someone who was raised in a family that includes someone with a PD (or alcoholism) to assume that behavior is 'normal' and typical of other families.
Personality Disorders are poorly defined constructs (concepts) in psychology, but they are chronic and long-lasting mental conditions that are NOT expected to improve over time without treatment. If you think you're going to 'fix' one in someone else (or help somebody else with a substance abuse problem), then look up the word 'codependent' and beware.
By definition, all Personality Disorders may affect someone's:
1) Cognition, how we think and perceive ourselves, others and the world
2) Affectivity, how we experience and process emotions
3) Interpersonal functioning, the way we think, feel and behavior in relationships
4) Impulse control, how we, oh look, potato chips
Estimates of the prevalence of Personality Disorders (PD's) in the general population tend to vary wildly, since clinical diagnosis of a PD is rather subjective. Estimates are that ~9-15% of the population has one or more PD's (their criteria tend to overlap so people with them often qualify for more than one, thus most really difficult people are a blend of two or more).
The 10 Personality Disorders defined in the DSM-5 and estimates of their prevalence/frequency:
Cluster A (odd or eccentric disorders):
-- Schizotypal personality disorder: ~3.9%* [0.6-4.6%, correlated to INTP by a study]
-- Paranoid personality disorder: ~0.5–2.5% [more common in males]
-- Schizoid personality disorder: ~0.8%** [some estimates as high as 4%, more common in males]
Cluster B (dramatic, emotional or erratic disorders):
-- Histrionic personality disorder: ~1.8% [2–3%, 2-4 times more often in females]
-- Antisocial personality disorder: ~1.8% [more common in males]
-- Borderline personality disorder: ~1.6% [1-2% (up to 6%), 3 times more often in females]
-- Narcissistic personality disorder: ~1%** [more common in males, CEO's and politicians]
Cluster C (anxious or fearful disorders):
-- Obsessive-compulsive personality disorder: ~2.1% to 7.9%* [twice as often in males; correlated to ISTJ by a study]
-- Avoidant personality disorder: ~2.4% [2.1-2.6%, equal in males and females]
-- Dependent personality disorder: ~0.5%** [50% more often in females]
* <one of the most common PD>
** <one of the least common PD> [however ~10% of people show sub-clinical narcissistic traits]
Note: If you added those frequency % numbers for all 10 PD's you'd get ~20%, but the % of all people with a PD is only ~9-15% because many people who qualify for a clinical diagnosis of a PD qualify for more than one.
Some of the PD's are relatively less likely to cause problems for others, particularly strangers or casual acquaintances (e.g. Schizotypal, Schizoid, Avoidant), while others can be extremely toxic to deal with even in passing but especially closely (e.g. Antisocial, Narcissistic, Histrionic, Paranoid), and a few are perhaps a mixed-blessing nuisance (e.g. Obsessive-compulsive, Dependent, Borderline).
It is worth learning about the PD's so that you can determine if you or anyone in your past (e.g. parents, siblings, school friends) or current relationships showed or shows the signs of them at a sub-clinical (mild to moderate) or clinical (severe, diagnoseable) level, so you can figure out what effect that may have had on you and what you might want to do about it (e.g. get therapy, or start setting boundaries with someone, or just realize that they weren't 'normal' or a standard of what to expect from others or a good role model). A fun and interesting introduction to the PD's is: Emotional Vampires: Dealing with People Who Drain You Dry by Albert J. Bernstein, but there are plenty of websites and YouTube videos with information, so searching on the name of one of the PD's will yield a vast amount of links.
There is a concept in popular (pop) psychology of the 'Dark Triad' of the worst toxic personality characteristics, consisting of Machiavellianism, Narcissism, and Psychopathy (some sources add Sadism as a fourth to make it a tetrad). Only one of the three in the 'Dark Triad' has a directly corresponding PD in the DSM-5, Narcissistic Personality Disorder. Another, Psychopathy, loosely corresponds to to Anti-Social Personality Disorder (ASPD) in the DSM-5 (though ASPD does feature the lack of empathy and remorse and lawlessness attributed to 'Psychopaths' in pop psychology, those with ASPD crave excitement and stimulation so it is a bit more specific). Machiavellianism is considered to be learned behavior, not a PD, and is thus under conscious control.
[Raj, my OC who was intentionally 'created' as a daemon, had 2 out of the 3 'Dark Triad' traits, his saving grace (quite literally as it turned out) is that he wasn't a Sadist or Narcissist and had a very practical and realistic grasp of his abilities and limitations, his strengths and weaknesses (because it was very much in his own self-interest to have a realistic view of his abilities, so that he could avoid attempting things that were beyond them, which is a good way to end up in the dead-book), and thus ultimately identified his Dark Triad traits as weaknesses and started trying to find ways around them in order to improve his long-term chances for success.]
Of these three most toxic types of personality characteristics (the 'Dark Triad' of Machiavellianism, Narcissism, and Psychopathy) the most subtle and difficult to spot can be Machiavellianism and Introverted Narcissism, which you might end up living with for years before discovering one day that there is a toxic person inside your mental shields or in your inner circle or in your bed. Here's some things to watch out for when getting to know new people and deciding who to trust.
7 Signs of a Covert Introvert Narcissist:
1. Self-Absorption
2. Lack of Empathy
3. Impersonal and Difficult Relationships
4. Passive-Aggressiveness
5. Highly Sensitive
6. The “Misunderstood Special Person”
7. Quiet Smugness/Superiority
Note that of the 7 signs listed above #1, 2 & 3 tend to be reasonably easy to relate to the common usage of the term 'narcissism', but #4, 5, 6 and 7 can seem like something else entirely even when you recognize them. Not every quietly haughty, highly-sensitive, misunderstood 'arteest' (artist) [or physicist, or anything else for that matter] who has difficulty with even the most constructively worded feedback and lashes out at critics with passive-aggressive behavior is a covert narcissist, but the warning signs indicate that proceeding with caution and doing some research is highly advisable, like googling the terms "introverted narcissist", "covert narcissist", and "vulnerable narcissist" sometime before the engagement and wedding to this “Misunderstood Special Person” (LOL). [This advice is far too late for my mother, but maybe someone else will benefit from it.]
Pathological Narcissism Inventory (PNI): In 2009 a group of researchers (Picnus, et. al.) created an idea/construct that they called sub-clinical 'Pathological Narcissism' to differentiate the new construct from clinical Narcissistic Personality Disorder (NPD) as defined in the DSM-5 that affects about 1% of the population and also differentiate it from 'normal' or healthy traits that may be considered narcissistic but that do not tend to cause personal distress or poor life outcomes. Their objective was to produce a construct of traits that were related to a common root problem or problems (that were not specifically identified) that were considered narcissistic and were correlated with personal distress and poor life outcomes. They did some research to create a set of 52 self-report questions that could identify 'Pathological Narcissism' (they named their 2009 questionnaire the Pathological Narcissism Inventory, or PNI, to distinguish it from an older 1979 questionnaire that is commonly used in studies called the Narcissism Personality Inventory, or NPI, which these researchers determined correlated more closely with clinical NPD and with 'normal/healthy' narcissism) and to identify how many distinct different dimensions that were included in the new construct so they could select questions that focused on only one dimension each without capturing multiple dimensions in any single question, so that the questionnaire would be useful in identifying the amount of each of the unique dimensions a respondent possessed, as well as an overall score. Later researchers developed a brief version, the B-PNI, with only 28 questions.
"Pathological Narcissism": A fairly elaborate amount of statistical analysis showed that their new construct of 'Pathological Narcissism' had 7 unique different dimensions that could be gathered into two main significant groupings, Grandiose Narcissism and Vulnerable Narcissism. The former concept, Grandiose Narcissism, correlates reasonably closely with the DSM-5 definition of NPD, which tends to focus on extroverted grandiosity (which is very easy to observe). The latter concept, alternatively called Introverted, Covert, or Vulnerable Narcissism in popular psychology literature, has garnered quite a bit of attention in the last decade (the 2010's), though as with everything in the soft/social sciences experts tend to disagree about definitions, groupings, models, and details and there have even been some questions of whether and how the concept of Vulnerable Narcissism differs from the DSM-5 construct of Borderline Personality Disorder (BPD), which isn't too surprising since NPD and BPD are both grouped in the 'cluster B' group of related personality disorders in the DSM-5. Cluster B includes four disorders: antisocial, narcissistic, borderline, and histrionic, which are all characterized by dramatic, overly emotional or unpredictable thinking/behavior and interactions with others; which makes them real nuisances to have to deal with and thus extremely popular subjects for popular/amateur psychology articles.
7 dimensions of 'Pathological Narcissism' in two main groupings (with corresponding octant on the 'interpersonal problems circumplex'):
Grandiose Narcissism traits/dimensions:
1. Entitlement Rage (Vindictive/Domineering) [later moved to the Vulnerable Narcissism grouping]
2. Exploitativeness (Domineering)
3. Grandiose Fantasy (Intrusive)
4. Self-Sacrificing Self Enhancement (Overly-nurturant)
Vulnerable Narcissism traits/dimensions:
5. Contingent Self-esteem (Exploitable)
6. Hiding the Self (Avoidant)
7. Devaluing (Cold/Vindictive)
8 octants of the interpersonal problems circumplex:
1. Domineering
2. Intrusive
3. Overly-nurturant
4. Exploitable
5. Nonassertive
6. Avoidant
7. Cold
8. Vindictive
That's enough for now about the 'sometimes hard to spot' Covert Introverted Narcissists and the 'very different from classical grandiose NPD' subclinical Vulnerable Pathological Narcissists (who might not be that much different from people with Borderline PD). Let's move on to some of the effects it may have on a person and what to do about it.
What if you had toxic people in your life before you had the ability to control who is in your life (e.g. your parents or caregivers were toxic people*), or if there are toxic people that you cannot exclude (e.g. family, a boss, or a coworker), or you let toxic people into your life before you made a decision to exclude toxic people, or you accidentally summoned a demon without a proper protective pentagram or pentacle? Well that might have affected your 'Attachment Style'.
*note that ‘clinical’ personality disorders are uncommon but not rare, about 9-15% of people qualify for one or more personality disorders, so depending on the assumptions you make and how you do the math about 14-28% of families with two parents will have a parent with a ‘clinical’ personality disorder; and that's without considering sub-clinical levels of the personality disorders and other issues like substance abuse or psychiatric problems other than the personality disorders, such as autism spectrum, Asperger's, schizophrenia, bipolar, dementia, Alzheimer's, mood disorders, anxiety disorders, PTSD, etc., not to mention plain ol' jerks. While every family has problems, disagreements, arguments, etc., not every family has a parent with a PD and it is likely that over 75% of families don't. Alternatively, if you considered the chance of each parent having a PD to be independent then the chance of a family having both parents with PD's would be about 1-2%; however that is likely a bad assumption because some of the PD's tend to be attracted to each other. In particular, Narcissists tend to attract codependents (Dependent PD or OCPD, especially anxiety-ridden ones).
6 Signs You Are Too Defensive for Your Own Good (Sometimes, being a fierce self-advocate can trip you up):
1. You’re always on the lookout for signs of exclusion.
2. Your first instinct is to distrust someone’s motivations.
3. You read ambiguity into situations and then obsess about them.
4. You don’t entirely trust your own feelings and thoughts, but you act on them anyway.
5. You never feel entirely safe, but always feel defensive.
6. Deep down, your defensiveness is fed by a stream of negative thoughts.
If you identify with some or all of those 6 you might want to review some information about Paranoid, Schizotypal, Schizoid, Obsessive-Compulsive, and Avoidant personality disorders and see if the diagnostic criteria fits; however just because you have a difficult time with relationships doesn't mean you have one or more of those personality disorders, heh, you might just be an Introvert who has some difficulties in your Adult Attachment Style.
Here are some places to find more info on Attachment Style:
Wikipedia on Attachment theory in general, and Attachment in adults.
Psychology Today's basics on Attachment.
A blogger's article on attachment.
A book with a website including some Q&A and a free test of attachment style.
Psychology Today's test with a free basic result, $6.95 for full results.
An article on How Your Attachment Style Colors Your World.
Here's one more warning that popular psychology articles, self-help authors, bloggers, and the like aren't necessarily the best or most scientific resources so use caution and look for confirmation or whatever your personal strategy for validating information is.
What are the problems of not having a 'Secure' attachment style, and what can you do about it:
- This explains the problems of Dismissive-Avoidant attachment. (Attachment style may be the single most significant thing that I need to work on myself.)
- If you had a toxic childhood, here are 10 lessons you must unlearn.
- If you want a relevant support group, or to try a 12-step program, there's Adult Children of Alcoholics and Dysfunctional Families (their daily meditation may help), there's also Al-Anon and CoDA, which all focus on past or present dysfunctional relationships in one way or another.
(2 of those 3 have removed the gender-specific references to 'God' in their versions of the 12 steps and 12 traditions, but the other has too many Al-A-Nazis to whom the traditional 1950's wording of the holy CAL (Conference Approved Literature) is sacrosanct... and probably use a Jealous God who permits no other gods before HIM as their own Higher Power, despite the fact that all of that CAL specifically allows everyone to find their own Higher Power and specifically allows Pantheism and feminine Higher Powers. Sigh, sadly they are exactly where they belong because Al-Anon is effectively OCPD-Anonymous, it just makes that particular organization difficult for others.)
- Much of the advice you'd find in a 12-step program can also be found in ancient Greek and Roman philosophy of Stoicism. The ancient Greek and Roman Stoics (who were the inventors/forerunners of modern CBT therapy) had good advice on relevant topics like Epictetus'
Discourses or Seneca's Antidote to Anxiety and Advice on Friendship, or Cicero’s De Officiis (On Moral Duties) which is his comprehensive study and writing on the ethical system of the Stoics of his time.
Now it is time to go back to the issue of people with personality disorders or the 'Dark Triad' traits, because there's a very important connection between them and Attachment Style. The following paragraphs reflect my personal opinions and ethics, feel free to form your own.
Note that it is impossible to have a 'Secure' attachment to people/beings who are not capable of having emotionally reciprocal relationships, such as anti-socials, narcissists, Machiavellians, and psychopaths (i.e. people lacking both empathy and an ethic of reciprocity, such as the 'Golden Rule') [yes young Raj I'm talking about you]. Any mutually 'healthy' relationship with someone in one of those categories will be purely transactional and based on mutual benefit with strong boundaries that are rigorously enforced with well defined consequences (and possibly legal contracts). In relationships with others you need to be able to identify those people as quickly as possible and switch to transactional interaction quickly, or never leave transactional interaction if that's where you started with them, such as a very self-centered and self-interested business associate with whom you have mutually beneficial business dealings. Note that all of these types of people will take advantage of any proffered friendship and provide little or nothing in return for as long as the friendship is offered (narcissists for instance, will just assume that they are entitled to such treatment just for being their awesome selves) and the more manipulative types will specifically attempt to get others to offer friendship/concern for them and will try to keep it coming to their own benefit for as long as possible. The Disney Lion Guard song "Jackal Style" is a warning about these sorts of people (as well as equating them to jackals and thus being rabidly species-ist against jackals) [though Raj does deserve that reputation]. Don't try to make any of these people your friends or treat them like friends, you won't be doing either of you any favors! They 'deserve' what they get for not following the 'Golden Rule' and what they both deserve and need to receive is transactional interactions, because they certainly aren't going to change if they don't have to; especially if they can get the benefits of the Golden Rule (concern from others for their well-being) without needing to reciprocate. While nobody chose to have genetics and childhood experiences that incline them toward narcissistic or anti-social behavior (or any other personality disorder, or to be introverted, autistic, or an INTJ or anything else that is beyond their control for that matter) that doesn't entitle anyone to special treatment or give them an exemption from the Golden Rule [yes young Raj I'm talking about you again]. Whatever you do, DON'T become their co-dependent, if you do then you deserve what you get (see Al-Anon, CoDA or ACA, or ask your therapist about co-dependence)! Keep it transactional and make sure they pay for all the benefits they receive or suffer the defined consequences. The very best of these sorts of beings will openly tell you up front that they prefer a transactional interaction style and will have the self-confidence, skills, and independence to make it work for them, without wanting or needing others to care about their well-being (they will be very mercenary and probably worth what they charge) [yes Raj I'm talking about you after you matured a bit]...
Back to the subject of how to cope with the results of current or past relationships with toxic people including those with PD's or the 'Dark Triad', or coping with your own genetic inclinations towards PD's or other psychiatric issues...
Here's some different types of therapy:
Cognitive Behavioral Therapy (CBT) is quite popular (based on ancient Stoic philosophy)
Dialectical Behavior Therapy (DBT)
Interpersonal psychotherapy (IPT)
Acceptance and commitment therapy (ACT)
Existential therapy is essentially what step 3 of a 12-step program is about
Logotherapy is Victor Frankel's version of existential therapy (with parallels to Stoic philosophy)
Psychodynamic therapy
Of course there's also good old fashioned psychoanalysis, which tries to determine the historical/experiential source of your problems. My short and humorous example is:
Patient: Doc you gotta help me, I keep clucking and flapping my arms.
Analyst: Zo, how long have you zought you ver a chicken?
Patient: Well, it started just after I saw the hot new Broadway show, "The Amazing Alexander - The World's Greatest Hypnotist"
Analyst: Ah, I zink we hav found ze root of your problem.
Patient: I loved it. It was much better than Cats. I'm going to see it again and again.
That's all for now. I will probably update this periodically. Feel free to recommend new links.
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This journal was great. Much better than Cats. I'm going to read it again and again.
IMHO, if you are going to have healthy, positive, nourishing relationships, you need to be able to identify and then either avoid or be able to cope with people who have psychological problems. So to be able to do well at one of the most important things for personal well-being someone needs to know some amateur psychology.
(This may be particularly important for people who are Introverted Intuitive Thinkers (INT's in Jungian type talk) who tend to have difficulty 'reading' and relating to others. Yes, that's me, I'm either INTJ or INTP.)
Since this Journal is going to be about psychology, which is a 'soft' science, I wanted to include a few caveats/disclaimers in advance so that it would be less likely that someone would 'attack' the Journal, my thinking, or myself on these issues. Psychological 'problems' tend to be put in categories which are given names so that they can be discussed but they are mostly rather ill-defined concepts [like lots of things in the soft/social sciences] and some are probably the combination of tens or hundreds or thousands or hundreds of thousands of factors [a combination of multiple factors or dimensions, like many things in the soft/social sciences], all of which exist on a continuum [like most everything in the soft/social sciences, where nothing is black and white and everything is in degrees or shades of gray], and experts can debate, disagree, and/or have conflicting theories and opinions [like lots of things in the soft/social sciences] which may be controversial [and probably are] and only qualified experts can offer expert opinions or diagnoses. The fact that I'm sufficiently concerned/defensive about being 'attacked' just for trying to discuss a 'soft' science topic that I'd bother to write this paragraph is an indication of one or more of my problems. [Specifically, my dysfunctional family dislikes discussing psychology as it might pertain to a family member and uses these and other statements as defense, denial, lecturing and accusation to shut down the discussion.]
There are lots of possible psychological problems, so focusing on the ones that a person is most likely to encounter and that are insidious or potentially difficult to identify and require special behaviors/tactics to deal with (other than just telling them to go to a mental health professional). In particular it is especially helpful to be able to identify and avoid people with Personality Disorders. Estimates vary but ~9-15% of the population has one or more disorder, so this is not a negligible issue (for comparison, the WHO estimates ~5% of the world population suffers from alcohol use disorders and ~18% are heavy episodic drinkers, while according to the CDC ~7% of the US adult population reported heavy alcohol use and ~16% reported binge drinking, so the issue about as prevalent as alcohol abuse). Among the potential psychological problems someone may encounter, the Personality Disorders (PD's) are particularly problematic because they're long term and ego-syntonic (i.e. someone with a PD usually does not think they have a problem or have any motivation to change). Whereas someone with anxiety or depression or post-traumatic stress disorder (PTSD), for instance, generally recognizes they have a problem and would be glad to change if there was an easy way to do so. The PD's also don't involve externally visible signs (like pills or bottles) or tend to get progressively worse over time like substance abuse does, making them potentially somewhat more insidious if you don't know how to spot or deal with them. It is also very easy for someone who was raised in a family that includes someone with a PD (or alcoholism) to assume that behavior is 'normal' and typical of other families.
Personality Disorders are poorly defined constructs (concepts) in psychology, but they are chronic and long-lasting mental conditions that are NOT expected to improve over time without treatment. If you think you're going to 'fix' one in someone else (or help somebody else with a substance abuse problem), then look up the word 'codependent' and beware.
By definition, all Personality Disorders may affect someone's:
1) Cognition, how we think and perceive ourselves, others and the world
2) Affectivity, how we experience and process emotions
3) Interpersonal functioning, the way we think, feel and behavior in relationships
4) Impulse control, how we, oh look, potato chips
Estimates of the prevalence of Personality Disorders (PD's) in the general population tend to vary wildly, since clinical diagnosis of a PD is rather subjective. Estimates are that ~9-15% of the population has one or more PD's (their criteria tend to overlap so people with them often qualify for more than one, thus most really difficult people are a blend of two or more).
The 10 Personality Disorders defined in the DSM-5 and estimates of their prevalence/frequency:
Cluster A (odd or eccentric disorders):
-- Schizotypal personality disorder: ~3.9%* [0.6-4.6%, correlated to INTP by a study]
-- Paranoid personality disorder: ~0.5–2.5% [more common in males]
-- Schizoid personality disorder: ~0.8%** [some estimates as high as 4%, more common in males]
Cluster B (dramatic, emotional or erratic disorders):
-- Histrionic personality disorder: ~1.8% [2–3%, 2-4 times more often in females]
-- Antisocial personality disorder: ~1.8% [more common in males]
-- Borderline personality disorder: ~1.6% [1-2% (up to 6%), 3 times more often in females]
-- Narcissistic personality disorder: ~1%** [more common in males, CEO's and politicians]
Cluster C (anxious or fearful disorders):
-- Obsessive-compulsive personality disorder: ~2.1% to 7.9%* [twice as often in males; correlated to ISTJ by a study]
-- Avoidant personality disorder: ~2.4% [2.1-2.6%, equal in males and females]
-- Dependent personality disorder: ~0.5%** [50% more often in females]
* <one of the most common PD>
** <one of the least common PD> [however ~10% of people show sub-clinical narcissistic traits]
Note: If you added those frequency % numbers for all 10 PD's you'd get ~20%, but the % of all people with a PD is only ~9-15% because many people who qualify for a clinical diagnosis of a PD qualify for more than one.
Some of the PD's are relatively less likely to cause problems for others, particularly strangers or casual acquaintances (e.g. Schizotypal, Schizoid, Avoidant), while others can be extremely toxic to deal with even in passing but especially closely (e.g. Antisocial, Narcissistic, Histrionic, Paranoid), and a few are perhaps a mixed-blessing nuisance (e.g. Obsessive-compulsive, Dependent, Borderline).
It is worth learning about the PD's so that you can determine if you or anyone in your past (e.g. parents, siblings, school friends) or current relationships showed or shows the signs of them at a sub-clinical (mild to moderate) or clinical (severe, diagnoseable) level, so you can figure out what effect that may have had on you and what you might want to do about it (e.g. get therapy, or start setting boundaries with someone, or just realize that they weren't 'normal' or a standard of what to expect from others or a good role model). A fun and interesting introduction to the PD's is: Emotional Vampires: Dealing with People Who Drain You Dry by Albert J. Bernstein, but there are plenty of websites and YouTube videos with information, so searching on the name of one of the PD's will yield a vast amount of links.
There is a concept in popular (pop) psychology of the 'Dark Triad' of the worst toxic personality characteristics, consisting of Machiavellianism, Narcissism, and Psychopathy (some sources add Sadism as a fourth to make it a tetrad). Only one of the three in the 'Dark Triad' has a directly corresponding PD in the DSM-5, Narcissistic Personality Disorder. Another, Psychopathy, loosely corresponds to to Anti-Social Personality Disorder (ASPD) in the DSM-5 (though ASPD does feature the lack of empathy and remorse and lawlessness attributed to 'Psychopaths' in pop psychology, those with ASPD crave excitement and stimulation so it is a bit more specific). Machiavellianism is considered to be learned behavior, not a PD, and is thus under conscious control.
[Raj, my OC who was intentionally 'created' as a daemon, had 2 out of the 3 'Dark Triad' traits, his saving grace (quite literally as it turned out) is that he wasn't a Sadist or Narcissist and had a very practical and realistic grasp of his abilities and limitations, his strengths and weaknesses (because it was very much in his own self-interest to have a realistic view of his abilities, so that he could avoid attempting things that were beyond them, which is a good way to end up in the dead-book), and thus ultimately identified his Dark Triad traits as weaknesses and started trying to find ways around them in order to improve his long-term chances for success.]
Of these three most toxic types of personality characteristics (the 'Dark Triad' of Machiavellianism, Narcissism, and Psychopathy) the most subtle and difficult to spot can be Machiavellianism and Introverted Narcissism, which you might end up living with for years before discovering one day that there is a toxic person inside your mental shields or in your inner circle or in your bed. Here's some things to watch out for when getting to know new people and deciding who to trust.
7 Signs of a Covert Introvert Narcissist:
1. Self-Absorption
2. Lack of Empathy
3. Impersonal and Difficult Relationships
4. Passive-Aggressiveness
5. Highly Sensitive
6. The “Misunderstood Special Person”
7. Quiet Smugness/Superiority
Note that of the 7 signs listed above #1, 2 & 3 tend to be reasonably easy to relate to the common usage of the term 'narcissism', but #4, 5, 6 and 7 can seem like something else entirely even when you recognize them. Not every quietly haughty, highly-sensitive, misunderstood 'arteest' (artist) [or physicist, or anything else for that matter] who has difficulty with even the most constructively worded feedback and lashes out at critics with passive-aggressive behavior is a covert narcissist, but the warning signs indicate that proceeding with caution and doing some research is highly advisable, like googling the terms "introverted narcissist", "covert narcissist", and "vulnerable narcissist" sometime before the engagement and wedding to this “Misunderstood Special Person” (LOL). [This advice is far too late for my mother, but maybe someone else will benefit from it.]
Pathological Narcissism Inventory (PNI): In 2009 a group of researchers (Picnus, et. al.) created an idea/construct that they called sub-clinical 'Pathological Narcissism' to differentiate the new construct from clinical Narcissistic Personality Disorder (NPD) as defined in the DSM-5 that affects about 1% of the population and also differentiate it from 'normal' or healthy traits that may be considered narcissistic but that do not tend to cause personal distress or poor life outcomes. Their objective was to produce a construct of traits that were related to a common root problem or problems (that were not specifically identified) that were considered narcissistic and were correlated with personal distress and poor life outcomes. They did some research to create a set of 52 self-report questions that could identify 'Pathological Narcissism' (they named their 2009 questionnaire the Pathological Narcissism Inventory, or PNI, to distinguish it from an older 1979 questionnaire that is commonly used in studies called the Narcissism Personality Inventory, or NPI, which these researchers determined correlated more closely with clinical NPD and with 'normal/healthy' narcissism) and to identify how many distinct different dimensions that were included in the new construct so they could select questions that focused on only one dimension each without capturing multiple dimensions in any single question, so that the questionnaire would be useful in identifying the amount of each of the unique dimensions a respondent possessed, as well as an overall score. Later researchers developed a brief version, the B-PNI, with only 28 questions.
"Pathological Narcissism": A fairly elaborate amount of statistical analysis showed that their new construct of 'Pathological Narcissism' had 7 unique different dimensions that could be gathered into two main significant groupings, Grandiose Narcissism and Vulnerable Narcissism. The former concept, Grandiose Narcissism, correlates reasonably closely with the DSM-5 definition of NPD, which tends to focus on extroverted grandiosity (which is very easy to observe). The latter concept, alternatively called Introverted, Covert, or Vulnerable Narcissism in popular psychology literature, has garnered quite a bit of attention in the last decade (the 2010's), though as with everything in the soft/social sciences experts tend to disagree about definitions, groupings, models, and details and there have even been some questions of whether and how the concept of Vulnerable Narcissism differs from the DSM-5 construct of Borderline Personality Disorder (BPD), which isn't too surprising since NPD and BPD are both grouped in the 'cluster B' group of related personality disorders in the DSM-5. Cluster B includes four disorders: antisocial, narcissistic, borderline, and histrionic, which are all characterized by dramatic, overly emotional or unpredictable thinking/behavior and interactions with others; which makes them real nuisances to have to deal with and thus extremely popular subjects for popular/amateur psychology articles.
7 dimensions of 'Pathological Narcissism' in two main groupings (with corresponding octant on the 'interpersonal problems circumplex'):
Grandiose Narcissism traits/dimensions:
1. Entitlement Rage (Vindictive/Domineering) [later moved to the Vulnerable Narcissism grouping]
2. Exploitativeness (Domineering)
3. Grandiose Fantasy (Intrusive)
4. Self-Sacrificing Self Enhancement (Overly-nurturant)
Vulnerable Narcissism traits/dimensions:
5. Contingent Self-esteem (Exploitable)
6. Hiding the Self (Avoidant)
7. Devaluing (Cold/Vindictive)
8 octants of the interpersonal problems circumplex:
1. Domineering
2. Intrusive
3. Overly-nurturant
4. Exploitable
5. Nonassertive
6. Avoidant
7. Cold
8. Vindictive
That's enough for now about the 'sometimes hard to spot' Covert Introverted Narcissists and the 'very different from classical grandiose NPD' subclinical Vulnerable Pathological Narcissists (who might not be that much different from people with Borderline PD). Let's move on to some of the effects it may have on a person and what to do about it.
What if you had toxic people in your life before you had the ability to control who is in your life (e.g. your parents or caregivers were toxic people*), or if there are toxic people that you cannot exclude (e.g. family, a boss, or a coworker), or you let toxic people into your life before you made a decision to exclude toxic people, or you accidentally summoned a demon without a proper protective pentagram or pentacle? Well that might have affected your 'Attachment Style'.
*note that ‘clinical’ personality disorders are uncommon but not rare, about 9-15% of people qualify for one or more personality disorders, so depending on the assumptions you make and how you do the math about 14-28% of families with two parents will have a parent with a ‘clinical’ personality disorder; and that's without considering sub-clinical levels of the personality disorders and other issues like substance abuse or psychiatric problems other than the personality disorders, such as autism spectrum, Asperger's, schizophrenia, bipolar, dementia, Alzheimer's, mood disorders, anxiety disorders, PTSD, etc., not to mention plain ol' jerks. While every family has problems, disagreements, arguments, etc., not every family has a parent with a PD and it is likely that over 75% of families don't. Alternatively, if you considered the chance of each parent having a PD to be independent then the chance of a family having both parents with PD's would be about 1-2%; however that is likely a bad assumption because some of the PD's tend to be attracted to each other. In particular, Narcissists tend to attract codependents (Dependent PD or OCPD, especially anxiety-ridden ones).
6 Signs You Are Too Defensive for Your Own Good (Sometimes, being a fierce self-advocate can trip you up):
1. You’re always on the lookout for signs of exclusion.
2. Your first instinct is to distrust someone’s motivations.
3. You read ambiguity into situations and then obsess about them.
4. You don’t entirely trust your own feelings and thoughts, but you act on them anyway.
5. You never feel entirely safe, but always feel defensive.
6. Deep down, your defensiveness is fed by a stream of negative thoughts.
If you identify with some or all of those 6 you might want to review some information about Paranoid, Schizotypal, Schizoid, Obsessive-Compulsive, and Avoidant personality disorders and see if the diagnostic criteria fits; however just because you have a difficult time with relationships doesn't mean you have one or more of those personality disorders, heh, you might just be an Introvert who has some difficulties in your Adult Attachment Style.
Here are some places to find more info on Attachment Style:
Wikipedia on Attachment theory in general, and Attachment in adults.
Psychology Today's basics on Attachment.
A blogger's article on attachment.
A book with a website including some Q&A and a free test of attachment style.
Psychology Today's test with a free basic result, $6.95 for full results.
An article on How Your Attachment Style Colors Your World.
Here's one more warning that popular psychology articles, self-help authors, bloggers, and the like aren't necessarily the best or most scientific resources so use caution and look for confirmation or whatever your personal strategy for validating information is.
What are the problems of not having a 'Secure' attachment style, and what can you do about it:
- This explains the problems of Dismissive-Avoidant attachment. (Attachment style may be the single most significant thing that I need to work on myself.)
- If you had a toxic childhood, here are 10 lessons you must unlearn.
- If you want a relevant support group, or to try a 12-step program, there's Adult Children of Alcoholics and Dysfunctional Families (their daily meditation may help), there's also Al-Anon and CoDA, which all focus on past or present dysfunctional relationships in one way or another.
(2 of those 3 have removed the gender-specific references to 'God' in their versions of the 12 steps and 12 traditions, but the other has too many Al-A-Nazis to whom the traditional 1950's wording of the holy CAL (Conference Approved Literature) is sacrosanct... and probably use a Jealous God who permits no other gods before HIM as their own Higher Power, despite the fact that all of that CAL specifically allows everyone to find their own Higher Power and specifically allows Pantheism and feminine Higher Powers. Sigh, sadly they are exactly where they belong because Al-Anon is effectively OCPD-Anonymous, it just makes that particular organization difficult for others.)
- Much of the advice you'd find in a 12-step program can also be found in ancient Greek and Roman philosophy of Stoicism. The ancient Greek and Roman Stoics (who were the inventors/forerunners of modern CBT therapy) had good advice on relevant topics like Epictetus'
Discourses or Seneca's Antidote to Anxiety and Advice on Friendship, or Cicero’s De Officiis (On Moral Duties) which is his comprehensive study and writing on the ethical system of the Stoics of his time.
Now it is time to go back to the issue of people with personality disorders or the 'Dark Triad' traits, because there's a very important connection between them and Attachment Style. The following paragraphs reflect my personal opinions and ethics, feel free to form your own.
Note that it is impossible to have a 'Secure' attachment to people/beings who are not capable of having emotionally reciprocal relationships, such as anti-socials, narcissists, Machiavellians, and psychopaths (i.e. people lacking both empathy and an ethic of reciprocity, such as the 'Golden Rule') [yes young Raj I'm talking about you]. Any mutually 'healthy' relationship with someone in one of those categories will be purely transactional and based on mutual benefit with strong boundaries that are rigorously enforced with well defined consequences (and possibly legal contracts). In relationships with others you need to be able to identify those people as quickly as possible and switch to transactional interaction quickly, or never leave transactional interaction if that's where you started with them, such as a very self-centered and self-interested business associate with whom you have mutually beneficial business dealings. Note that all of these types of people will take advantage of any proffered friendship and provide little or nothing in return for as long as the friendship is offered (narcissists for instance, will just assume that they are entitled to such treatment just for being their awesome selves) and the more manipulative types will specifically attempt to get others to offer friendship/concern for them and will try to keep it coming to their own benefit for as long as possible. The Disney Lion Guard song "Jackal Style" is a warning about these sorts of people (as well as equating them to jackals and thus being rabidly species-ist against jackals) [though Raj does deserve that reputation]. Don't try to make any of these people your friends or treat them like friends, you won't be doing either of you any favors! They 'deserve' what they get for not following the 'Golden Rule' and what they both deserve and need to receive is transactional interactions, because they certainly aren't going to change if they don't have to; especially if they can get the benefits of the Golden Rule (concern from others for their well-being) without needing to reciprocate. While nobody chose to have genetics and childhood experiences that incline them toward narcissistic or anti-social behavior (or any other personality disorder, or to be introverted, autistic, or an INTJ or anything else that is beyond their control for that matter) that doesn't entitle anyone to special treatment or give them an exemption from the Golden Rule [yes young Raj I'm talking about you again]. Whatever you do, DON'T become their co-dependent, if you do then you deserve what you get (see Al-Anon, CoDA or ACA, or ask your therapist about co-dependence)! Keep it transactional and make sure they pay for all the benefits they receive or suffer the defined consequences. The very best of these sorts of beings will openly tell you up front that they prefer a transactional interaction style and will have the self-confidence, skills, and independence to make it work for them, without wanting or needing others to care about their well-being (they will be very mercenary and probably worth what they charge) [yes Raj I'm talking about you after you matured a bit]...
IMHO there is nothing inherently wrong with someone who wants to be a Chaotic Neutral (or even a Type 1 Neutral Evil) Ayn Rand-ian Objectivist* and they can be very productive members of society, but such people need to be dealt with using their own transactional worldview, and excluded from the positive benefits of the brotherhood of beings (sisterhood of sapients) who follow the Golden Rule. When handled transactionally, they can be much easier to deal with than someone who is selflessly trying to do what they see as being 'good' for others from their own viewpoint (and either ignoring what those others want or feel is best for themselves (c.f. codependency & authoritarianism & boundary violations), or ignoring the countless secondary effects of their actions on yet others who are not the direct beneficiary, the classic 'unseen cost' in economics).
*or other less scrupulous self-centered philosophies, c.f. Thrasymachus in chapter 1 of Plato's Republic, Glaucon (playing 'devils advocate') in chapter 2 of Plato's Republic, Callicles from Plato's dialogue Gorgias, or (debateably) Nietzsche. Also, to be clear, I haven't read Any Rand's classic novels yet and I might be mis-characterizing Objectivism.
To extend that to RPG's, if you are GM'ing for a player who has this worldview or who is playing a character who has this worldview, you should NEVER do any favors for them or cut them any slack, always give them exactly the result that the dice call for! If the dice call for a critical hit against them, don't modify it, if the dice call for them to have a random encounter with something that is both more powerful than them and hostile to them, then that's what they should get (and it is totally up to them if and how they'll survive it).Back to the subject of how to cope with the results of current or past relationships with toxic people including those with PD's or the 'Dark Triad', or coping with your own genetic inclinations towards PD's or other psychiatric issues...
Here's some different types of therapy:
Cognitive Behavioral Therapy (CBT) is quite popular (based on ancient Stoic philosophy)
Dialectical Behavior Therapy (DBT)
Interpersonal psychotherapy (IPT)
Acceptance and commitment therapy (ACT)
Existential therapy is essentially what step 3 of a 12-step program is about
Logotherapy is Victor Frankel's version of existential therapy (with parallels to Stoic philosophy)
Psychodynamic therapy
Of course there's also good old fashioned psychoanalysis, which tries to determine the historical/experiential source of your problems. My short and humorous example is:
Patient: Doc you gotta help me, I keep clucking and flapping my arms.
Analyst: Zo, how long have you zought you ver a chicken?
Patient: Well, it started just after I saw the hot new Broadway show, "The Amazing Alexander - The World's Greatest Hypnotist"
Analyst: Ah, I zink we hav found ze root of your problem.
Patient: I loved it. It was much better than Cats. I'm going to see it again and again.
That's all for now. I will probably update this periodically. Feel free to recommend new links.
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This journal was great. Much better than Cats. I'm going to read it again and again.
