From the earliest attempts by psychiatrists to diagnose longstanding deficits in adaptive functioning known as personality disorders to the most recent revision of the Diagnostic and Statistical Manual (DSM) in 2013, there has been confusion and controversy: How many of these disorders are there, how distinct are they from one another, do they show stability over time, and, importantly, can people who have them be cured?
Some disorders seem to provide sources of endless fascination to professionals and laypersons alike, such as narcissistic , antisocial , and borderline personality disorders. Each term has become part of popular parlance, even as their exact meanings become blurred and potentially distorted with each passing year.
The situation is not aided by the fact that psychiatrists and psychologists are at odds over whether there are, in fact, distinct personality disorders, or whether they rest on one or more continuums or dimensions. The old “Axis II” of the previous DSM put the disorders onto a separate plane from other psychological conditions that, in contrast, were regarded as true “diseases” that could be “cured.” Axis II, by contrast, was a part of the fabric of the individual’s psyche that could not be excised.
In a new version of an old approach to personality disorders as reflecting “styles” rather than stable disorders, University of Minnesota psychologist Sylvia Wilson and colleagues (2017) took the perspective of interpersonal theory to examine the interpersonal styles associated with each personality disorder. As they note, “Interpersonal style is defined by one’s characteristic approach to interpersonal situations and relationships” (p. 679). It includes the attitudes you have toward relationships, your goals in your relationships, how you interpret what happens in your relationships, the way you behave, and the way you interpret the behaviors of others. This all-inclusive concept, further, determines the quality of essentially all of your relationships, from those closest to you to the ones you interact with on a more formal basis.
You can detect an individual’s interpersonal style almost immediately upon meeting: Is this a person who seems friendly, easygoing, and amiable? Or do you pick up the vibes of someone who is suspicious, closed-minded, and cold? It’s often easy to spot someone who seems just a bit “too” friendly and whom you discover to be insincere or possibly unaware of boundaries. The idea of interpersonal style would seem to fit well with the personality disorder framework because so much of what can go awry in personality involves relationships with others.
The theoretical underpinnings of interpersonal style fall into an approach popular in the mid-20th century postulating that “all interpersonal interactions reflect attempts to establish and maintain self-esteem or avoid anxiety” (p. 679). According to this view, you’re constantly trying to feel good about yourself in your relationships, because to recognize weakness would make you feel anxious. At some level, the theory proposes, we’re always searching for approval and validation.
Moving on to the content of the interpersonal theory, Wilson and her colleagues propose that all personality traits can be cataloged on the dimensions of agency (ranging from domination to submissiveness) and communion (ranging from warmth to coldness). These dimensions form a “circumplex,” or a circle with two dimensions that, in turn, can be divided into eight sections, like the slices of a pie. At the extreme end of dominance is autocratic , and at the extreme end of the cooperative dimension, you find the trait of being overly nurturant . In between these two ends is the trait of intrusiveness. The closer you get to the extreme ends of any dimension, the less desirable a trait becomes, as shown with warmth. You can be, according to this model, too warm.
The eight traits identified in this manner are as follows: domineering, vindictive, cold, socially avoidant, nonassertive, exploitable, overly nurturant, and intrusive . Personality measures based on the circumplex model have, Wilson and collaborators claim, considerable validity and have been used in a wide range of applications. Using the research method known as meta-analysis in which questions are addressed across a large number of studies, the authors screened nearly 4,800 papers examining interpersonal relationships across personality disorders. They ended up with a selection of 127 studies conducted over a 20-year period providing data on the eight personality traits defined by the circumplex model associated with each personality disorder.
The authors conducted 120 separate analyses, which also included indicators of interpersonal style and functioning in interpersonal area domains, including family, peers, parent-child, and romantic partner. This rigorous approach yielded distinct interpersonal style profiles for each of the 10 major personality disorders, taking into account, as well, sex, age, and type of sample (clinical or non-clinical). Some of the analyses included as many as 13,000 individuals.
The extensive results provide profiles useful not only for classification but also for understanding how people within each of the disorders approach their relationships. For people in relationships with such individuals, it’s a framework that could help you understand them in more depth.
With this in mind, let’s examine the main interpersonal traits for each disorder:
- Paranoid. Vindictive and cold stand out as the two predominant themes. To a lesser extent, people with this personality disorder are also intrusive.
- Schizoid. Coldness with a combination of social avoidance form the main traits for this personality disorder’s profile. It’s unlikely that schizoid individuals, according to the findings, will try to exploit you.
- Schizotypal. Individuals with this personality disorder score high on all three of the above traits — namely, vindictive, cold, and avoidant. This profile fits with the disorder’s main criterion of odd, eccentric, and socially awkward behavior.
- Antisocial. The extreme of the psychopathic personality, people with this disorder scored high on the traits of domineering, vindictive, and intrusive, with slightly high scores on coldness.
- Borderline. A broad set of interpersonal traits appeared in the studies of people with borderline personality disorder, but the highest scores were on vindictive and intrusive. You might experience this when with someone who has this disorder, particularly when you feel that your boundaries are being violated and you’re being held accountable to an extreme degree for your behaviors and possible shortcomings.
- Histrionic. This personality disorder is rarely diagnosed and was almost eliminated in the new DSM. However, the interpersonal trait profile showed distinctly high scores on domineering and, particularly, intrusiveness. These individuals are unlikely, in contrast, to be cold and socially avoidant.
- Narcissistic. Remarkably similar to antisocial in the interpersonal style model, individuals with this personality disorder were also high in domineering, vindictive, cold, and intrusive interpersonal style traits. These qualities are ones that you’ll almost invariably encounter when dealing with people who fit this diagnostic category.
- Avoidant. As you might expect, people high in avoidant personality disorder are most likely to be high on coldness and social avoidance, but low on domineering and intrusiveness. As the avoidant personality disorder is so aptly described in terms of interpersonal relationships, it makes sense that the profile as revealed in research fits this pattern.
- Dependent. The dependent personality disorder showed a pattern of scores marked by the highest scores on intrusiveness and lowest, as you might expect, on domineering. Individuals with this disorder, who have an excessive need to be taken care of, readily submit to others. Their second-highest score was on vindictiveness, but they were also high on exploitativeness.
- Obsessive-compulsive. There were no stand-out features of this personality disorder in the overall analysis, which yielded a relatively flat profile across the eight traits. This finding suggests that perhaps this personality disorder doesn’t involve as much interpersonal dysfunction as has been thought, although individuals who fit the criteria of excessive perfectionism, inflexibility, and restricted expression of emotions may have trouble at work or in relationships. They may also, however, achieve higher status and wealth, as other research has indicated. There’s a trade-off, then, when an individual has such an extreme work ethic that he or she may pay less attention to relationships.
Summarizing the findings, the authors concluded that, without question, the “personality disorders are associated with dysfunctional interpersonal styles” and “core disturbances in self” (p. 720). From a diagnostic point of view, the authors also believe that the idea of discarding the personality disorder categories and replacing them with a rating system also receives support from their findings. All but obsessive-compulsive personality disorder appeared to have impaired interpersonal relationships, which in some of the analyses were particularly strong for family and less so for romantic domains.
There is still much to be learned about personality disorders, as the authors note. However, these findings suggest that cutting to the core of relationship difficulties and disturbances in sense of self provides the best way of understanding people who seem to fit the personality disorder definition. You don’t need to become a diagnostician to be able to use these findings in your daily life. Looking at people who may be narcissistic or psychopathic in terms of their interpersonal style rather than discrete categories provides perhaps a more realistic, if not sympathetic, way of relating to them.
Copyright Susan Krauss Whitbourne, 2017
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders- Revised (DSM-5). Washington DC: Author.
Wilson, S., Stroud, C. B., & Durbin, C. E. (2017). Interpersonal dysfunction in personality disorders: A meta-analytic review. Psychological Bulletin, 143(7), 677-734. doi:10.1037/bul0000101