A person’s broadly characteristic traits, coping styles, and ways of interacting in the social environment emerge during childhood and normally crystallize into established patterns by the end of adolescence or early adulthood. These patterns constitute the individual’s personality—the set of unique traits and behaviors that characterize the individual. Today there is reasonably broad agreement among personality researchers that about five basic personality trait dimensions can be used to characterize normal personality. This five-factor model of personality traits includes the following five trait dimensions: neuroticism, extraversion/introversion, openness to experience, agreeableness/antagonism, and conscientiousness (e.g., Goldberg, 1990 ; John & Naumann, 2008 ; McCrae & Costa, 2008 ).
Clinical Features of Personality Disorders
For most of us, our adult personality is attuned to the demands of society. In other words, we readily comply with most societal expectations. In contrast, there are certain people who, although they do not necessarily display obvious symptoms of most of the disorders discussed in this book, nevertheless have certain traits that are so inflexible and maladaptive that they are unable to perform adequately at least some of the varied roles expected of them by their society, in which case we may say that they have a personality disorder (formerly known as a character disorder). Two of the general features that characterize most personality disorders are chronic interpersonal difficulties and problems with one’s identity or sense of self (Livesley, 2001 ).
In the case below, many of the varied characteristics of someone with a personality disorder are illustrated.
Narcissistic Personality Disorder Bob, age 21, comes to the psychiatrist’s office accompanied by his parents. He begins the interview by announcing he has no problems…. The psychiatrist was able to obtain the following story from Bob and his parents. Bob had apparently spread malicious and false rumors about several of the teachers who had given him poor grades, implying that they were having homosexual affairs with students. This, as well as increasingly erratic attendance at his classes over the past term, following the loss of a girlfriend, prompted the school counselor to suggest to Bob and his parents that help was urgently needed. Bob claimed that his academic problems were exaggerated, his success in theatrical productions was being overlooked, and he was in full control of the situation. He did not deny that he spread the false rumors but showed no remorse or apprehension about possible repercussions for himself.
Bob is a tall, stylishly dressed young man. His manner is distant but charming …. However, he assumes a condescending, cynical, and bemused manner toward the psychiatrist and the evaluation process. He conveys a sense of superiority and control over the evaluation…. His mother … described Bob as having been a beautiful, joyful baby who was gifted and brilliant. The father … noted that Bob had become progressively more resentful with the births of his two siblings. The father laughingly commented that Bob “would have liked to have been the only child.” … In his early school years, Bob seemed to play and interact less with other children than most others do. In fifth grade, after a change in teachers, he became arrogant and withdrawn and refused to participate in class. Nevertheless, he maintained excellent grades…. It became clear that Bob had never been “one of the boys.” … When asked, he professed to take pride in “being different” from his peers…. Though he was well known to classmates, the relationships he had with them were generally under circumstances in which he was looked up to for his intellectual or dramatic talents. Bob conceded that others viewed him as cold or insensitive … but he dismissed this as unimportant. This represented strength to him. He went on to note that when others complained about these qualities in him, it was largely because of their own weakness. In his view, they envied him and longed to have him care about them. He believed they sought to gain by having an association with him.
Source: Adapted with permission from DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (pp. 239–41) (Copyright © 2002), Washington, DC. American Psychiatric Association.
According to general DSM-5 criteria for diagnosing a personality disorder, the person’s enduring pattern of behavior must be pervasive and inflexible, as well as stable and of long duration. It must also cause either clinically significant distress or impairment in functioning and be manifested in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse control. From a clinical standpoint, people with personality disorders often cause at least as much difficulty in the lives of others as they do in their own lives. Other people tend to find the behavior of individuals with personality disorders confusing, exasperating, unpredictable, and, to varying degrees, unacceptable. Whatever the particular trait patterns affected individuals have developed (obstinacy, covert hostility, suspiciousness, or fear of rejection, for example), these patterns color their reactions to each new situation and lead to a repetition of the same maladaptive behaviors because they do not learn from previous mistakes or troubles. For example, a dependent person may wear out a relationship with someone such as a spouse by incessant and extraordinary demands such as never being left alone. After that partner leaves, the person may go almost immediately into another equally dependent relationship without choosing the new partner carefully.
Personality disorders typically do not stem from debilitating reactions to stress in the recent past, as do posttraumatic stress disorder (PTSD) or many cases of major depression. Rather, these disorders stem largely from the gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of perceiving, thinking about, and relating to the world. In many cases, major stressful life events early in life help set the stage for the development of these inflexible and distorted personality patterns.
The category of personality disorders is broad, encompassing behavioral problems that differ greatly in form and severity. In the milder cases we find people who generally function adequately but who would be described by their relatives, friends, or associates as troublesome, eccentric, or hard to get to know. Like Bob, they may have difficulties developing close relationships with others or getting along with those with whom they do have close relationships. One severe form of personality disorder (antisocial personality disorder) results in extreme and often unethical “acting out” against society. Many such individuals are incarcerated in prisons, although some are able to manipulate others and keep from getting caught