They call him "the Shark."
Bill, a 26-year-old lawyer, is proud of his nickname and the ruthlessness that inspired it. Confident and charming, he can also be arrogant, manipulative and deceptive—though he sees nothing wrong with these qualities, useful as they are in winning cases and attracting women. Lately, however, Bill's character has been landing him in trouble. He's begun abusing cocaine. He can't resist the temptations of strip clubs and casinos. He's already been married and divorced twice. Even his successful career has been endangered by his habit of propositioning female coworkers. Bill is bothered enough that he pays a visit to a psychologist's office. There he's told that he has an "antisocial" personality: He consistently, and often unscrupulously, places his own interests above those of others. Bill's antisocial tendencies pervade his entire way of being—just as someone with a narcissistic personality can't see past his own grandiosity or someone with an obsessive-compulsive personality can't lift her eyes from her meticulous, exacting tasks.
The idea that human nature can be refracted through personality traits—distinct clusters of thoughts and feelings that color all of a person's actions—has been around a long time. But it is gaining new momentum. For one thing, it gives us a high-definition picture of human character and its variety. It also encourages renewed appreciation for the diversity of influences on behavior, from genes to lifestyles. As a result, the new view of personality heralds a revolution in how we view disorder, marking a shift away from rigid categories of pathology to a more organic sense of the way individuals fit in their world. After all, aren't lawyers supposed to be aggressive? Aren't, say, actors almost universally narcissistic? Aren't accountants and copy editors rewarded for their compulsive attention to detail?
For many years, serious problems of character and personality were believed to be relatively rare. What's more, they were regarded as virtually untreatable—and bereft of any benefit or utility. Personality disorders were sequestered on their own island of pathology.
But a flood of new theories, surveys and techniques is sweeping aside the old assumptions about problematic personalities. Dysfunctional personalities actually appear to be quite common, affecting more than 30 million Americans—about one person in seven. This increased awareness of the prevalence of personality problems is stimulating breakthroughs in understanding and treating them, as well as a dawning realization that what we call mental illness might once have had, and may still serve, highly adaptive functions. Most surprising of all, researchers are accumulating evidence that the line between normal and abnormal personality is much more subtle than anyone imagined. Which may mean that our conception of mental illness is due for a revision—and that we "normal" people are all just a little bit crazy. From Quirk to Quagmire Central to the emerging perspective is a distinction between personality styles and personality disorders. Any specific pattern of thinking and feeling may be expressed as a healthy, though perhaps quirky, personality style, or it may be expressed more floridly as a clinically diagnosable personality disorder. Psychologists recognize 10 different personality types that, when manifest in intense form, represent 10 distinct personality disorders.
People with an avoidant personality, for example, may be homebodies who like routine and cherish a few intimates, or they may shun people for fear of rejection and avoid risk-taking or new activities for fear of the humiliation of failure. The former have an avoidant personality style, the latter an avoidant personality disorder. Likewise, people with a histrionic personality may merely enjoy attention and be entertainingly dramatic, although able to cede the stage to others when appropriate. Those with histrionic personality disorder insist on being the center of attention and have emotional problems as well; their feelings are shallow and ever-shifting, and they may have difficulty intimately connecting with others.
So what's the difference between a personality disorder and a personality style? One gauge is, simply, extremity: The personality disordered think, feel and act in ways that are at the outer edge of what most people experience. A second guideline is inflexibility. Says Randolph Nesse, a psychiatrist at the University of Michigan: "Most of us are angry sometimes and loving sometimes, nice sometimes and mean sometimes. But people with personality disorders keep doing the same things over and over again.
Their emotional palette isn't varied; it's monochromatic." They get stuck, unable to respond fluidly to changing circumstances. Their daily functioning is also impaired. A clinician evaluating someone for a personality disorder would ask two key questions: Has the patient's personality contributed to a loss of relationships? Has it contributed to career failure? Thomas Widiger, a University of Kentucky psychologist who diagnosed Bill the Shark, adds a subjective measure: How much distress is a person feeling as a result of his personality problems? If these distinctions seem less black-and-white than shades of gray, they are. And in fact, many psychologists are shifting from the old you-have-it-or-you-don't perspective on personality disorders (the "categorical" model) to the more nuanced "dimensional" model. In it, personality is located along a continuum, with healthy personality traits at one end, personality disorders at the other—and innumerable gradations in between.
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