Am I Normal?

But the implications of the new work on personality disorders go far beyond parochial diagnostic matters. It represents a sea of change in how we view psychological health and illness. As Thomas Widiger says, "The patterns found in personality disorders really are traits that are distributed throughout the population, and we all have them to greater or lesser degree." The new research suggests that psychopathology is not alien and unfamiliar but rather recognizably human, an extension of what we all experience. That could soften the stigma that still attaches to mental illness.

Just as we may see something of ourselves in the volatile diva or the misanthropic recluse, we may also embrace the extreme, the flagrant, the florid in our own characters. The new work on personality disorders might allow us to rescue an array of traits and behaviors—the high spirits of a borderline personality, the single-minded intensity of an obsessive-compulsive—from the "pathological" category in which they've been deposited and reclaim them as rich additions to healthy human variety.

Context, Context, Context

Personality disorders contribute an important insight to reformulated ideas of mental health: Context is everything. Behavior that creates havoc in one situation may be celebrated in another, and finding the right niche may mean—for any one of us—the difference between psychological health and sickness. From this perspective, personality problems are not burdens we carry wherever we go but latent vulnerabilities that are exacerbated by specific environments. They are also potential assets.

Randolph Nesse offers an example. "Imagine a very dramatic woman—in DSM language, a 'histrionic' individual. If she goes to work for an accounting company, chances are she'll have lots of trouble, because she's more interested in impressions than details and because she's likely to be more impulsive and more emotionally expressive than the others who work there. She gets thrown out of the job, gets really depressed and shows up at the office of a therapist, who says, 'It's your personality that's the problem; you have a personality disorder.' Now imagine that same woman in the artistic world, where her attributes are actually an advantage. She'd be doing beautifully, would not show up at a psychologist's office and would not be diagnosed with a personality disorder. Yet this is the same person with the same constellation of traits—just two different contexts." The importance of specialized niches turns up again in investigations of the origins of personality disorders. One provocative notion emerging from evolutionary psychology is that many of the behaviors found in personality disorders—perverse as they may appear to us now—originated as adaptations necessary for survival.

And in fact, looking closely, it's not hard to see the germ of something useful in what on the surface appear to be self-defeating patterns of behavior. Avoidant personality disorder, for example, may be a holdover from a time when strangers posed a very real danger. "The insecurity and nervousness avoidant people feel about approaching others was in some contexts very adaptive," says Widiger. "It helped them develop a sense of caution about entering risky situations and risky relationships." Likewise, obsessive-compulsive personality disorder may be an exaggerated version of the directed and diligent efforts that helped some of our human ancestors thrive. The perfectionism, productivity and skinflint approach to money that characterizes this disorder may be remnants of organizing and hoarding behaviors that prepared communities for times of scarcity, Nesse speculates.

Conversely, some personality patterns may have rewarded the individual at a cost to the larger community. Stealing, cheating and manipulating got for some people what they couldn't obtain by more legitimate means, which may explain why researchers have found a small but stable population of individuals with antisocial personality disorder in societies all over the world. Such personality quirks have persisted because extreme behavior can still work to an individual's advantage. "One of the features of narcissism is enormous confidence and self-esteem," observes Widiger. "It takes a degree of narcissism to continue despite failures and setbacks, and narcissists quite often have very successful careers." People with dependent personality disorder may suffer for their exquisite sensitivity to relationships, says Nesse, "but I bet they make really good friends" and have stronger social networks as a result.