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Are Some Personality Disorders Polar Opposites of Others?

Arranging the personality disorders in terms of polar opposites.

Personality disorders represent a major class of psychopathology. They are characterized by long-standing problems with relationships and identity and emotional regulation, which leads to chronic maladaptive patterns and much distress. There are several different approaches to personality disorders. The most well-known is the DSM-5 classification system, which is a “categorical approach” that considers the personality disorders as different and discrete kinds of problems. Here is a good description of the 10 different kinds of personality disorders recognized by the DSM-5. The DSM divides the 10 personality disorders into three different clusters, A, B, and C. Disorders in Cluster A (schizoid, paranoid, schizotypal) are considered “odd and eccentric.” The Cluster B (antisocial, narcissistic, histrionic, borderline) are labeled “dramatic and erratic.” Finally, Cluster C (dependent, avoidance, obsessive-compulsive) are labeled “anxious and fearful.”

There are a number of alternative approaches to the DSM, such as the Psychodynamic Diagnostic Manual. Another approach that was almost adopted by the DSM-5, but was rejected at the last minute, is the dimensional-functional approach. The functional range stretches from healthy-resilient to neurotic to borderline to psychotic/completely disabled or detached from reality. An individual with a healthy or functional relationship system feels valued by important others, expresses attachment and compassion, and has a portfolio of strong, long-term relationships with family, friends, and romantic partners. They can effectively cooperate and demonstrate the capacity to appreciate other experiences, are able to hold conflicting feelings (e.g., guilt or anger) without being overwhelmed, and are able to narrate how they are perceived by others and how their actions play a role in the social exchange. In contrast, someone with dysfunctional relationship systems has significant trouble forming lasting, intimate relationships, has difficulty empathizing with others in complex and effective ways, often lacks insight into their own role in conflict and the responses that they elicit, has difficulty trusting or having compassion for others, and generally feels devalued by important others.

Theodore Millon was a great personality disorder theorist who argued that the self-other dimension was key (in addition to the pleasure-pain and active-passive polarities). But how should we map this self-other dimension? Attachment theory provides one powerful lens. The Influence Matrix is another, one that complements attachment theory by integrating it with the Circumplex Model. It maps the human relationship system into four distinct “relational process” dimensions (the dimensions are the lines — black, blue, red, and green).

Gregg Henriques
Source: Gregg Henriques

A cool thing about the Matrix is that it gives rise to a new way to think about personality disorders. That is, it shows that some personality disorders are opposites of one another. What might we mean by opposites? Think about someone who is mousy, unassertive, shy, submissive, and socially anxious, and then compare that to President Trump’s interpersonal style, which is basically the opposite (i.e., very assertive, dominant, competitive, etc.).

The Influence Matrix maps the human relationship system first on the “Black Line,” which is a combination of “relational value” and “social influence.” Relational value is the experience of being known and valued by important others. Social influence refers to the extent to which we can influence important others to behave in accordance with our interests. The RV-SI line is considered the central, key variable that guides human relationship processes. Personality disorders, by definition, create or involve RV-SI problems, which is why they are maladaptive.

The Matrix also identifies three relational process variables: power (dominance versus submission), love (affiliation versus hostility), and freedom (autonomy versus dependence). These process dimensions correspond closely to Karen Horney’s formulation of moving against (power), moving toward (love), and moving away (freedom).

This analysis gives rise to a new way to conceptually arrange personality disorders. First, remember the DSM clusters of A, B, and C? I don’t think the descriptions that they offer are great. In fact, the Matrix/Horney dimensions do a much better job at getting at the functional dimensions underlying the clusters. Cluster “A” folks move away. This is most obvious with paranoid and schizoid, but also true of schizotypal in that they tend to believe in “deviant” things that most conventional people don't. Cluster “B” folks move against. They compete, manipulate, and draw attention and engage in emotional warfare. Cluster “C” folks move toward. This is most obvious of dependent folks, but it is also true of avoidant folks in that they are lonely and anxious and long for connection, but they avoid it, because they fear being criticized and rejected more. (Obsessive-compulsive personality disorder is different in some ways — see below).

One of the coolest things about the Matrix/Horney arrangement is that it suggests that some personality disorders are polar opposites of others. The easiest way to see it is via the Personality Disorder Star. When we rate folks on high or low tendencies on moving away, against, or toward, we see that some personality disorders are well characterized in terms of being polar opposites of others.

Gregg Henriques
The Personality Disorder Star
Source: Gregg Henriques

For example, narcissistic personality disorder presentations are characterized by grandiosity, hyper-competitiveness, showiness, aggressive assertiveness, lacking empathy, and thinking one is superior to others. Avoidant personality is the exact opposite. Closely related to social anxiety disorder, folks with avoidant personality disorder feel inferior, shy, hate confrontation, and stay out of the spotlight to avoid conflict and embarrassment.

Dependent personality disorder is about subjugating oneself to be with others. It is driven by a fear of abandonment and a need for social connection and acceptance. In contrast, antisocial personality disorder is defined by a rejection of the demands of others and a willingness to manipulate others and break rules for selfish gain, even if it costs them approval.

Histrionic personality disorder is all about attention-seeking and engagement with others, often in a shallow way. These individuals are extroverted and dramatic and need the spotlight to be on them. Schizoid personality disorder is the complete opposite. Folks who meet the criteria for this disorder are completely detached from social connections and show little to no interest in either affiliation or status-seeking behaviors. (It is worth noting that paranoid personality disorder is also an extreme form of moving away, combined with some moving against).

WAYHOME studio/Shutterstock
Source: WAYHOME studio/Shutterstock

There is one dimension that is not a Matrix dimension, but it is an important dimension of human functioning that relates to emotional control. Obsessive-compulsive personality disorder is defined by a rigid and over-controlled style of being. In contrast, borderline personality disorder is defined by being emotionally out of control. Thus, I see a bit of an opposite there, but it is about being over- versus under-controlled rather than moving toward, away, or against.

The bottom line is, just as Karen Horney suggested, we can see that many personality disorders are characterized by rigid and extreme relational tendencies. When we combine Horney’s view with the Influence Matrix, we can see that some personality disorders (narcissistic-avoidant; dependent-antisocial; histrionic-schizoid) are polar opposites. This is a novel insight that can help map this complicated set of conditions better than the DSM cluster approach.

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