The experience of living with an abusive, disordered partner or family member is very similar across three disorders in what they call Cluster B of Axis II. In addition, I often see the wildcard disorder of addiction (which most often shows up as alcoholism, and recently meth abuse) as a compounding factor in many situations.
There is an awful lot said about disorders and “criteria”: the indications that professionals use to make diagnoses. There is also a lot of “free help” given in the form of non-specific traits that some people think help identify disorders, like being very charming. The result is a muddy soup that leads many people down the wrong path. I help people figure out what they’re dealing with when I consult, and in time I found that there was really one key thing I looked for both to identify and describe these disorders. I call them “essential dynamics” since they are really driving forces that motivate the abusive and distorted behavior. Admittedly, these run somewhat counter to the official diagnostic approach, but my experience helping people shows that these both work and they make good sense. BTW, if you’re interested in consulting, there’s a link on the right.
This essay, based on Meaning from Madness, describes the three most common personality disorders that I hear about from my readers and clients: borderline, narcissistic, and antisocial (sociopathic). I begin with my own perspective on the essential dynamic that drives each of these disorders. In the book I go into these in much more depth, especially narcissism, which I consider to be at the core of most abusive behavior regardless of the diagnosis or label a person may have. Then I present the actual definitions that come from the APA (American Psychiatric Association) reference book, the DSM-IV(Diagnostic and Statistics Manual).
Understanding what disorder you’re dealing with is a critical. It allows us to get some handle on why our partner behaves as he or she does. It also gives us some bounds on the reasonable probability of change – something we all hope for yet are most often frustrated about. Having a good picture of these things allows us make projections about what the future may hold, and thus allows us to make decisions about the future with some confidence.
My Definition of the Abusive Personality Disorders
In my writing and in supporting people who have been in abusive situations, I consistently see three personality disorders that lead people to behave abusively. These are what I call the abusive disorders, and they are borderline, narcissistic, and antisocial(sociopathic) personality disorders. Here, I want to give both a practical explanation of these three disorders, plus their “official” diagnostic definitions. In my practical explanations, I’m trying, not be exhaustive, but to highlight the essential dynamic that I see as unique to each of these disorders. This dynamic is essentially a key concept that can be kept in mind in thinking about these disorders.
Remember that personality disorders are defined by the presence of a minimum number of “diagnostic criteria”, which basically are behaviors with some underlying motivation. These are defined in the APA (American Psychiatric Association) reference book, the DSM-IV(Diagnostic and Statistics Manual) and I’ve included copies of those criteria after this essay. However, current thinking about these disorders is that they occur in a continuum of severity, with less severely impacted people having what is called a “personality style”, and the most severely impacted being diagnosed with a personality disorder. Thus, the essential dynamic I describe may help you identify a personality style where the criteria may not necessarily be met.
The Essential Dynamics
Both borderline and narcissistic personality disorders are driven by grossly hypersensitive reactions to perceived threats. Borderlines perceive a threat of significant people abandoning them, and react very strongly to protect themselves either by stopping the abandonment or pushing the perceived abandoner out of their significant space. Narcissists find safety in presenting an image of perfection to others, and react very strongly to any threat to that image, usually by attacking and demeaning the person making that perceived threat. Sociopaths, in contrast, have a total LACK of sensitivity to the needs and feelings of others. Sociopaths may be aggressive or passive or in between, but in all cases lack a sense of conscience or remorse. Their actions tend to be more measured than those suffering with borderline or narcissistic personality disorder, but their measure of goodness of actions completely lacks concern for others and is based entirely on the impact they perceive their actions will have on themselves.
Borderlines fear abandonment and react strongly to actions they perceive indicate that they are being abandoned.
Narcissists fear that their perfect image in others’ eyes will be damaged, and react strongly to any threat to that image.
Sociopaths lack remorse and conscience and choose actions only with regard to their impact on themselves.
These are not the same words you may hear used by others, but I think they capture the essence of these disorders.
What follows are the official definitions of these disorders
Although you may be cautioned otherwise, do not shy away from assessing these criteria in someone close to you. In reality, partners or close family have far more necessary knowledge of a person to assess these criteria than any mental health professional can ever have. If the criteria make sense, then evaluate the fit. Most people are reasonably able to determine which of these disorders is likely present in a partner or family member. With that information, you can research and learn what the prospects are for improvement and what such a healing process would be like.
DSM Definitions – The Abusive Personality Disorders
What follows are the official definitions of these disorders. Although you may be cautioned otherwise, do not shy away from assessing these criteria in someone close to you. In reality, partners or close family have far more necessary knowledge of a person to assess these criteria than any mental health professional can ever have. If the criteria make sense, then evaluate the fit. Most people are reasonably able to determine which of these disorders is likely present in a partner or family member. With that information, you can research and learn what the prospects are for improvement and what such a healing process would be like.
The DSM is a reference work of the American Psychiatric Association containing the definition of mental disorders. The four disorders below are grouped in what is called in Cluster B of Axis II. The disorders in Axis II are all personality disorders.
DSM Definition – Borderline Personality Disorder
A person who suffers from this disorder has labile interpersonal relationships characterized by instability. This pattern of interacting with others has persisted for years and is usually closely related to the person’s self-image and early social interactions. The pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner) in a person’s affect, or feelings. Relationships and the person’s affect may often be characterized as being shallow. A person with this disorder may also exhibit impulsive behaviors and exhibit a majority of the following symptoms:
* frantic efforts to avoid real or imagined abandonment.
* a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
* identity disturbance: markedly and persistently unstable self-image or sense of self
* impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
* recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
* affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
* chronic feelings of emptiness
* inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
* transient, stress-related paranoid ideation or severe dissociative symptoms
DSM Definition – Narcissistic Personality Disorder
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
4. requires excessive admiration
5. has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
6. is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
7. lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
8. is often envious of others or believes that others are envious of him or her
9. shows arrogant, haughty behaviors or attitudes
DSM Definition of Antisocial Personality Disorder (psychopathic, sociopathic)
This disorder is characterized by a long-standing pattern of a disregard for other people’s rights, often crossing the line and violating those rights.
This pattern of behavior has occurred since age 15 (although only adults 18 years or older can be diagnosed with this disorder) and consists by the presence of the majority of these symptoms:
* failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
* deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
* impulsivity or failure to plan ahead
* irritability and aggressiveness, as indicated by repeated physical fights or assaults
* reckless disregard for safety of self or others
* consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
* lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
DSM Definition of Histrionic Personality Disorder-Rounding out Cluster B
HPD is the fourth and final PD in Cluster B of Axis II. I am totally unfamiliar with it, but it is with the big 3 abusive disorders, and I’m guessing there’s a reason.
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. is uncomfortable in situations in which he or she is not the center of attention
2. interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
3. displays rapidly shifting and shallow expression of emotions
4. consistently uses physical appearance to draw attention to self
5. has a style of speech that is excessively impressionistic and lacking in detail
6. shows self-dramatization, theatricality, and exaggerated expression of emotion
7. is suggestible, i.e., easily influenced by others or circumstances
8. considers relationships to be more intimate than they actually are.