Masochistic Personality, Revisited

Key Points:

• Masochistic tendencies—excessive self-defeating behavior, a constant need to please others, and the reflexive denial of positive regard—are not formally recognized as a personality disorder.
• But some clinicians continue to diagnose what was once called "masochistic personality disorder," and such traits may benefit from treatment even without a formal diagnosis.
• Therapists can help patients "unlearn" negative core beliefs about themselves by reinforcing the patient's worth as a person and showing genuine interest in them.

Unfortunately, we don’t choose our personalities. Personality is a combination of inheritance/genetics and how early life experience/nurturance influences us. Inherited components are called traits, and, collectively, traits are termed temperament. Learned behaviors are called habits, and the collection of habits is termed character. Join temperament and character, and you have a personality—all the things that influence how a person views themselves, the world, and how they interact with it.

While we all have personality quirks, perhaps an anxious temperament, or being too trusting, these individual quirks don’t likely cause global ripples in our optimal functioning. Those with disordered personalities exhibit collections of maladaptive thoughts and behaviors, which can be downright problematic, like Antisocial and Narcissistic Personality Disorders.

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Recently, I was reflecting on people with self-defeating, or masochistic, qualities to their personalities. Masochistic personality is not officially recognized by the American Psychiatric Association (APA). In the 1980s APA deemed there is too much overlap with Dependent Personality and the behaviors are better accounted for thus. Despite this, Jefferson (1986) noted, "The consistent and considerable literature which has evolved regarding the masochistic personality suggests that clinicians see this category as descriptively useful." It was also alleged masochistic personality is a sexist diagnosis and that political forces contributed to its erasure by the APA (Ruffalo, 2019).

Even so, not recognizing it doesn’t render it non-existent. masochistic personality continues to be recognized by many psychoanalysts, and by Millon (1996, 2021) as the aggrieved/masochistic personality. Despite APA not formally recognizing it, clinicians may still diagnose it. We would use: Unspecified Personality Disorder, Masochistic/Self-Defeating, and of course be detailed in the clinical formulation.

Categorization aside, self-defeating characteristics are not uncommon, like people-pleasing at one’s own expense or denying positive acknowledgment. At the extreme end of the self-defeating spectrum, there’s a sad, painful existence. Unfortunately, anyone working with youth has likely witnessed the underpinnings of a masochistic personality. I can't help but recall some court-involved families I’ve evaluated that included a very parentified child headed down the self-defeating path.

The Roots of Masochistic Self-Sabotage

Surely, you've encountered children attending to adult responsibilities. I've met kids who tend to bill paying and groceries because their mother was too anxious to leave the house and her boyfriend believed these tasks were below him. Others were saddled with getting siblings off the bus, fixing dinner, and getting siblings to bed because parents were disabled, working, abusing substances, or absentee.

Imagine being a child of an anxious temperament and having such forced responsibilities. If you don’t submit, you’re told you’re no good and selfish, or harshly punished. Being anxious, you’re likely to cave to the demands. You've been groomed, your lot is taking care of others’ needs before yours, if at all; clearly, your needs aren't important. Identity and self-worth become based on caretaking, even as a child. It's the only thing you’re rewarded for. Sadly, personalities are solidifying between ages 7 and 13.

The maladaptive habits follow them into social, educational settings, and eventually careers. The habit of pleasing others, for example, is globalized, and in school the kid doesn’t simply help a classmate with a paper; they write it for them, even at the expense of their own grade. It's as if to say, "Use me. It gives me value. Besides, it's selfish to think of my needs.”

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As a teen, relationships are increasingly with “projects” needing care, or people inviting painful experiences. After all, isn’t love about being shackled to negative experiences, like in the family of origin? A substance-abusing partner, for example, is enabled because if they ceased, the self-defeatist couldn’t sacrifice for them. Despite complaints of relational struggles, they never seem willing to let go.

Why Masochistic Personalities Are Often Martyrs

Our maturing masochistic personality eventually reaches a state where all satisfaction is derived from self-defeat. Being a martyr is admirable, is it not? The masochist pats themselves on the back for sacrifice and asceticism, wearing it as a badge. “Look at everything I do for others!” they advertise. Though they may seek “selfish” satisfactions from personal interests or healthy relationships at times, they invariably self-sabotage, as such achievement is too anxiety-provoking given its correlation to guilt: “How dare you indulge yourself?!” emanates from unconscious crevices storing early life experiences.

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They’ve never been able to morph from the mold they were cast in many years ago; to do so would disrupt their sense of identity and any self-worth they harbor. Hanging onto this proud unselfishness, as Millon called it (1996), is the only sense of merit they are able to muster, and they must keep in practice to maintain their trophy.

Treatment Implications for Masochistic Personalities

While some say they are too similar to deserve independent recognition, it's important to differentiate dependent and masochistic personality conditions. While many conditions share symptoms, as discussed in Schizophrenia or Schizotypal, that doesn’t mean they’re similarly treated. In this case, while dependency and people-pleasing arise in both conditions, dependent personalities need to be taken care of; masochistic/self-defeating personalities seek someone to sacrifice for.

As noted earlier, personality consists of genetic and learned components. Some have more of one than the other. Self-defeating practices are learned. Mercifully, if something is learned, it can be unlearned. Therefore, if clinicians recognize self-defeating characteristics it is helpful to examine the person's core beliefs about themselves and construct a therapy towards more adaptive views.

Such patients will likely resist directive therapeutic intervention given, to them, they’re being directed to erase that which they rely on: failing themselves. More subtle, interpersonal measures, such as a therapist modeling interest in the person's being and thus showing they have more to offer than sacrifice, can help to start altering faulty schema.

Lastly, in terms of children, while alerting social services to families where this scenario occurs may drive a wedge into the dynamics, for the time being, it doesn't stop there. The therapist must now consider the child’s belief about their role in life and examine and correct faulty core schema, so the child can grow up to feel important and value themselves and their own needs.

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