A large portion of abusers (although not all) have some similar identifying disorders, traits, or diagnosis. They are not all created equal. That means, each one of them brings a unique combination of traits, challenges, and problems to the equation of the relationship and even therapy. Therefore, not all abusers treatment is going to be effective because not all psychological problems are treatable. For instance, batterer intervention has often failed to make this distinction and lumps all violent behavior or psychological problems together as if the batterers are not differentiated by their differences in their mental health problems.
Some of the disorders have biological and neurological root causes that are not curable. Ultimately, not all problem relationships have a solution especially those that have biological and neuro problems at their basis. That's not popular to hear. We live in an Oprah-age of psychology that believes all disorders are curable and if not curable, at least highly treatable. 'Law of Attraction' type thinking pulls many people into believing 'if they think it, they can make it happen' (their relationship will work, the pathology will be gone, or something curative will happen that will drive away the symptoms.) Like medicine, psychology faces the same challenges that not all disorders have a satisfactory treatment, much less, a cure.
If people who are in problem relationships want to avoid future problem relationships, they have to understand what contributes to some of the disorders and the signs within the behavior. There is no doubt that chronic personality problems wreak havoc in relationships and the worst of these do have commonalities related to impulsivity, emotional dysregulation, and violence. (No abuse is mild. I'm not suggesting that. What I am trying to hone on is the chronicity and lethality of some of the relationships and what some of the contributing factors can be to those problems.)
Recent research in neuroscience helps us get a new view of the biological problems related to what Otto Kernberg (one of the renowned writers about personality disorders and pathology) wrote about regarding the 'severe personality disorders' related to Cluster B disorders. (See his books Aggression In Personality Disorders and Perversions; Severe Personality Disorders; Aggressivity, Narcissism and Self Destructiveness in the Psychotherapeutic Relationships—to name a few).
Neuroscience over the past few years has helped us understand the additional biological and neurological roots of some of these severe personality disorders and the disorders of sociopathy and psychopathy as well. MRI's of various Cluster B disorders and sociopathy/psychopath have lead the way noting similarities in brain formations, brain activity, brain circuitry, brain chemistry and its relationship to the severe disorders, impulsivity, poor treatment outcomes, and poor relationship outcomes. (The book Evil Genes by Barbara Oakley is great place to start reading about the neuro aspects of some of these disorders.)
Where therapy has spent decades (if not a century) focused on the very psychoanalytic, cognitive and behavioral approaches, we have missed the very real potential of neurology and brain functioning challenges in severe disorders. While the origins and etiology of these disorders has been widely debated for decades, neuroscience is providing many of the answers to biology that we previously didn't have. This helps us delineate between the mind as a structure and process and the brain as an organ.
The brain as an organ has all the proclivity of being born with differences, challenges, and problems as any other organ in the body. Unfortunately, up until now, the view has been a very 'psychological' approach to the brain and its disorders without looking at the possible contributions of 'nature' such as being born with biological predispositions.
(To learn more about this topic, read these interesting journal articles:
- Neural foundation of moral reasoning and antisocial behavior
- Into the Mind of a Killer: Brain imaging studies starting to venture into the research of criminal psychopathy
- Tridimensional Personality Questionnaire data on alcoholic violent offenders: specific connections to severe impulsive cluster B personality disorders and violent criminality
- The Relationship Between DSM-IV cluster b personality disorders and psychopathy according to Hare's criteria: Clarification and resolution of previous contradictions
- Brain imaging abnormalities in borderline personality disorder (video)
- Potentials implicate temporal lobe abnormalities in criminal psychopaths
- Hypomanic symptoms predict an increase in narcissism and histrionic personality disorders
- The Brain and Personality Disorders)
Just glancing at the titles we can see the mounting growth of information about the brain as an organ (and not just the mind as the emotions) and its relationships to severe disorders.
In fact, a number of mental health disorders, including some of the personality disorders, have genetic transmission. A frightening aspect is that antisocial and psychopathy are genetically transmitted probably more than the public realizes. While society doesn't question when it comes to the heart or immune system people can be born with abnormalities that affect those organs and systems, people certainly have a BIG reaction to the thought of psychology being related to brain organ issues and not merely emotional issues. (I didn't write the neuroscience research, I am only reporting on it!)
It helps illuminate that this country needs a Public Pathology Education Project to help the public understand which diagnosis have treatment options, and which are highly limited. Which diagnosis have the highest random violence rate associated with them. Which diagnosis has the highest criminality, addiction, and personal/intimate violence associated with it.
When looking at the behaviors associated with problem partners and what is referred to as 'severe personality disorders'/the problems of sociopathy and psychopath, we have to look broadly at the symptoms. Not so broadly that we find loopholes to ignore compelling examples of problematic behavior in the partner. But normally, one symptom off a behavioral list does not constitute one of the 'severe personality disorders' or the no conscienced disorders of sociopathy or psychopathy. On the other hand, they don't need to have all of these traits in order to be problematic in a relationship.
Those in relationships with problem partners often fail on the side of 'too much empathy' and give them more credit for not having these symptoms than what is warranted. Somewhere in the middle of one trait-too-many/and no-they-don't-have-problems-at-all, is a snapshot of relationship problems and problem partners.
Here are some of the behaviors associated associated with the ‘severe personality disorders' and also sociopathy and psychopathy. (Taken from the Diagnostic Statistical Manual—DSM IV)
___Disregard for, and the violation of, the rights of others
___Failure to conform to lawful social norms
___Deceitfulness Impulsivity or failure to plan ahead
___Irritability and aggressiveness as indicated by repeated physical fights or assaults
___Reckless disregard for the safety of self or others
___Consistent irresponsibility as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
(Above are related to Antisocial Personality Disorder)
___ Lack of remorse as indicated by being indifferent about having hurt, mistreated or stolen from another
___ Glib and superficial charm
___ Grandiose (exaggeratedly high) estimation of self
___ Need for stimulation
___ Pathological lying
___ Cunning and manipulativeness
___ Lack of remorse or guilt
___ Shallow affect (superficial emotional responsiveness)
___ Callousness and lack of empathy
___ Parasitic lifestyle
___ Poor behavioral controls
___ Sexual promiscuity
___ Early behavior problems
___ Lack of realistic long-term goals
___ Impulsivity irresponsibility
___ Failure to accept responsibility for own actions
___ Many short-term relationships
___ Juvenile delinquency
___ Revocation of conditional release
___ Criminal versatility
(Above are related to Sociopaths/Psychopaths)
___ Frantic efforts to avoid real or imagined abandonment
___ Intense and unstable personal relationships that over idealize and devalue
___ Identity disturbance with unstable self image or sense of self impulsivity in at least two areas
(spending, sex, substance abuse, reckless driving, binge eating)
___ Recurrent suicidal behavior, gestures, threats or self-mutilation
___ Emotional instability due to a marked reactivity of mood (intense episodic irritability or anxiety)
___ Chronic feelings of emptiness
___ Inappropriate intense anger or difficulty controlling anger
(Above are related to Borderline Personality Disorder)
___ A grandiose sense of self importance
___ Exaggerates their achievements and talents
___ Expects to be recognized as superior without commensurate achievements
___ Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
___ Believes that he is special and unique and can only be understood by, or should only associate with, other special or other high-status people or institutions.
___ Requires excessive admiration
___ Has a sense of entitlement, unreasonable expectations of especially favorable treatment or
automatic compliance with his expectations
___ Is interpersonally exploitative within relationships and takes advantage of others to achieve his own ends
___ Lacks empathy and is unwilling to recognize or identify with the feelings and needs of others
___ Is often envious of others or believes that others are envious of him
___ Shows an arrogant, haughty behavior or attitude
(Above are related to Narcissistic Personality Disorder)
This list is not mild relational infractions or merely what Dr. Phil refers to as 'deal breakers'. In some of the more chronic features and behaviors, this pathology causes debilitating partner aftermath symptoms. The Institute has been involved in offering recovery to those coming out of relationships with narcissists, antisocial, sociopathy and psychopaths for 20 years. That's because the chronicity of these disorders often causes chronicity within their relationships.
If that wasn't true, 100 million people would not be negatively affected by someone else's pathology. We wouldn't have support groups for "Partners of Narcissists" or "Adult Children of Narcissistic Personality Disorder." There wouldn't be self-help books for those harmed by antisocials or psychopaths. The Institute wouldn't have felt it necessary to write 'Women Who Love Psychopaths' and open hospital treatment programs for their survivors.
Some of those listed above on the checklists are the abusers who are not created equal, who have permanent neuro, emotional, behavioral and psychological disorders that bypass what psychology can do for them. Anger management—nope. Batterer intervention—nope. Intensive psychotherapy—nope. The permanent forms of pathology are noted for its Three Inabilities (Brown, 2005):
- Inability to grow to any authentic emotional or spiritual depth
- Inability to sustain positive change
- Inability to develop insight how their behavior negatively affects others
These inabilities are the hallmark of chronic disorders that create chronic problem relationships. Lacey, Staci and Nicole bear witness to the undiagnosed problems of problem partners. Bring your checklist above next time when I talk about how these characteristics affect the relationship dynamics! (For more information on Problem Partners contact us at www.saferelationshipsmagazine.com)