Personality

Personality is any person's collection of interrelated behavioral, cognitive and emotional patterns that comprise a person’s unique adjustment to life. These interrelated patterns are relatively stable, but can change over long time periods.

Although there is no consensus definition of personality, most theories focus on motivation and psychological interactions with one's environment. Trait-based personality theories, such as those defined by Raymond Cattell, define personality as traits that predict an individual's behavior. On the other hand, more behaviorally-based approaches define personality through learning and habits. Nevertheless, most theories view personality as relatively stable. The study of the psychology of personality, called personality psychology, attempts to explain the tendencies that underlie differences in behavior.

Psychologists have taken many different approaches to the study of personality, including biological, cognitive, learning, and trait-based theories, as well as psychodynamic, and humanistic approaches. The various approaches used to study personality today reflect the influence of the first theorists in the field, a group that includes Sigmund Freud, Alfred Adler, Gordon Allport, Hans Eysenck, Abraham Maslow, and Carl Rogers.

Personality Traits

In 1884, British scientist Francis Galton became the first person known to consider deriving a comprehensive taxonomy of human personality traits by sampling language. The idea that this may be possible is known as the lexical hypothesis. In 1936, American psychologists Gordon Allport and Henry Odbert implemented Galton's hypothesis creating a list of 4504 adjectives they believed were descriptive of observable and relatively permanent traits.

In 1943, the British-American Raymond Cattell of Harvard University took Allport and Odbert's list and reduced this to a list of "160 odd" terms by eliminating words with very similar meanings. To these, he added terms from 22 other psychological categories, and additional "interest" and "abilities" terms. This resulted in a list of 171 traits. From this he used factor analysis to derive 60 "personality clusters or syndromes", plus an additional 7 minor clusters. Cattell then narrowed this down to 35 terms, and later added a 36th factor in the form of an IQ measure. Through factor analysis in 1945, 1947, and 1948, he created 11 or 12 factor solutions.

Also in 1947, German-British psychologist Hans Eysenck of University College London published his book Dimensions of Personality. He posited that the two most important personality dimensions were "Extraversion" and "Neuroticism" (a term he himself coined). In July 1949, American Donald Fiske of the University of Chicago used 22 terms either taken or adapted from Cattell's 1947 study, and through surveys of male university students and statistics derived five factors: "Social Adaptability", "Emotional Control", "Conformity", "Inquiring Intellect", and "Confident Self-expression".

The Big Five

The Big Five personality traits, sometimes known as "the five-factor model of personality" or "OCEAN model", is a grouping of five unique characteristics used to study personality. It has been developed from the 1980s onward in psychological trait theory. Starting in the 1990s, the theory identified five factors and ten values. Each of the five factors may be further divided into two distinct values. These factors and values are as follows:

Each of the Big Five personality traits contains two separate, but correlated, aspects reflecting a level of personality below the broad domains but above the many facet scales also making up part of the Big Five. The aspects are labelled as follows:

When factor analysis is applied to personality survey data, it reveals semantic associations: some words used to describe aspects of personality are often applied to the same person. For example, someone described as conscientious is more likely to be described as "always prepared" rather than "messy". These associations suggest five broad dimensions used in common language to describe the human personality, temperament, and psyche.

The Big Five model was built to understand the relationship between personality and academic behaviour. It was defined by several independent sets of researchers who analysed words describing people's behaviour.

Those labels for the five factors may be remembered using the acronyms "OCEAN" or "CANOE". Beneath each proposed global factor, there are a number of correlated and more specific primary factors. For example, extraversion is typically associated with qualities such as gregariousness, assertiveness, excitement-seeking, warmth, activity, and positive emotions. These traits are not black and white; each one is treated as a spectrum.

Psychopathy Checklist

The Psychopathy Checklist or Hare Psychopathy Checklist-Revised, now the Psychopathy Checklist—revised (PCL-R), is a psychological assessment tool that is commonly used to assess the presence and extent of the personality trait psychopathy in individuals—most often those institutionalised in the criminal justice system—and to differentiate those high in this trait from those with antisocial personality disorder, a related diagnosable disorder. It is a 20-item inventory of perceived personality traits and recorded behaviors, intended to be completed on the basis of a semi-structured interview along with a review of "collateral information" such as official records.

An individual's score may have important consequences for their future, and because the potential for harm if the test is used or administered incorrectly is considerable, Hare argues that the test should be considered valid only if administered by a suitably qualified and experienced clinician under scientifically controlled and licensed, standardised conditions.

The psychopath tends to display a constellation or combination of high narcissistic, borderline, and antisocial personality disorder traits, which includes superficial charm, charisma/attractiveness, sexual seductiveness and promiscuity, affective instability, suicidality, lack of empathy, feelings of emptiness, self-harm, and splitting (black and white thinking). In addition, sadistic and paranoid traits are usually also present. The PCL was originally developed in the 1970s by Canadian psychologist Robert D. Hare for use in psychology experiments, based partly on Hare's work with male offenders and forensic inmates.

High PCL-R scores are positively associated with measures of impulsivity and aggression, Machiavellianism, persistent criminal behavior, and negatively associated with measures of empathy and affiliation.

Each of the 20 items in the PCL-R is scored on a three-point scale, with a rating of 0 if it does not apply at all, 1 if there is a partial match or mixed information, and 2 if there is a reasonably good match to the offender. This is to be done through a face-to-face interview together with supporting information on lifetime behavior (e.g., from case files). It can take up to three hours to collect and review the information. Out of a maximum score of 40, the cut-off for the label of psychopathy is 30 in the United States and 25 in the United Kingdom. A cut-off score of 25 is also sometimes used for research purposes.

Item 1 Item 2 Item 3 Item 4 Item 5
Glibness/superficial charm Grandiose sense of self-worth Need for stimulation/proneness to boredom Pathological lying Conning/manipulative
Item 6 Item 7 Item 8 Item 9 Item 10
Lack of remorse or guilt Shallow affect Callous/lack of empathy Parasitic lifestyle Poor behavioral controls
Item 11 Item 12 Item 13 Item 14 Item 15
Promiscuous sexual behavior Early behavior problems Lack of realistic long-term goals Impulsivity Irresponsibility
Item 16 Item 17 Item 18 Item 19 Item 20
Failure to accept responsibility for own actions Many short-term marital relationships Juvenile delinquency Revocation of conditional release Criminal versatility

The PCL-R is widely used to assess individuals in high-security psychiatric units, prisons and other settings. This may be of help in deciding who should be detained or released, or who should undergo what kind of treatment. It is also used in academic psychology for its original purpose as an assistive tool in studies on the pathology of psychopathy. The PCL-R is also used as a risk assessment tool that attempts to predict who will offend or reoffend (recidivism). It is effective in assessing risk of sexual re-offending, which is especially helpful, as clinical judgement of recidivism is a poor predictor. The PCL-R seems to be more useful for violent sexual offenders who are not pedophiles.

Notable PCL-R evaluations include:

Some research suggests that ratings made using the PCL system depend on the personality of the person doing the rating, including how empathic they themselves are. One forensic researcher has suggested that future studies need to examine the class background, race and philosophical beliefs of raters because they may not be aware of enacting biased judgments of people whose section of society or individual lives for whom they have no understanding of or empathy.

Dark Triad

The dark triad is a psychological theory of personality, first published by Delroy L. Paulhus and Kevin M. Williams in 2002, that describes three notably offensive, but non-pathological personality types: Machiavellianism, sub-clinical narcissism, and sub-clinical psychopathy. Each of these personality types is called dark because each is considered to contain malevolent qualities. All three dark triad traits are conceptually distinct although empirical evidence shows them to be overlapping.

They are associated with a callous–manipulative interpersonal style. High scores in these traits have been found to statistically increase a person's likelihood to commit crimes, cause social distress, and create severe problems for organisations, especially if they are in leadership positions. They also tend to be less compassionate, agreeable, empathetic, and satisfied with their lives, and less likely to believe they and others are good.

“Psychopaths are social predators who charm, manipulate, and ruthlessly plow their way through life, leaving a broad trail of broken hearts, shattered expectations, and empty wallets. Completely lacking in conscience and in feelings for others, they selfishly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret.”.

Robert D. Hare, 1993, p. xi

A factor analysis found that among the big five personality traits, low agreeableness is the strongest correlate of the dark triad, while neuroticism and a lack of conscientiousness were associated with some of the dark triad members. Research indicates that there is a consistent association between changes in agreeableness and the dark triad traits over the course of an individual's life.

Several researchers have suggested that sadism should be considered a fourth dark trait. While sadism is highly correlated with the dark triad, researchers have shown that sadism predicts anti-social behavior beyond the dark triad. Sadism shares common characteristics with psychopathy and antisocial behavior (lack of empathy, readiness for emotional involvement, inflicting suffering), although Reidy et al. (2011) showed that sadism distinctively predicted unprovoked aggression separate from psychopathy.

Harmful behavior against living creatures, brutal and destructive amoral dispositions, and criminal recidivism were additionally more prominently predicted by sadism than psychopathic traits.

Furthermore, sadism predicted delinquent behavior separately from the other dark triad traits when evaluating high school students. Studies on how sadists gain pleasure from cruelty to subjects were applied towards testing people who possessed dark triad traits. Results showed that only people exhibiting traits of sadism derived a sense of pleasure from acts of cruelty, concluding that sadism encompasses distinctly cruel traits not covered by the rest of the dark triad, therefore deserving of its position within the dark tetrad. In 2010, Dr Peter Jonason and his co-author, Gregory Webster developed the "Dirty Dozen" rating scale, or a 12-item methodology, to measure Dark Triad traits.

Research from 2013 suggests that consistently harsh or unstable parent-child relationships — which can often lead to insecurities related to attachment — could be a key contributing factor to these personality traits. According to Gauri Khurana, MD, MPH, a psychiatrist and a clinical instructor at Yale University School of Medicine, causes of the dark triad personality may be linked to: childhood neglect, physical, verbal, or sexual abuse in childhood, genetic factors. In situations of neglect or abuse.

The vulnerable dark triad comprises three related and similar constructs: vulnerable narcissism, sociopathy, and borderline personality disorder. A study found that these three constructs are significantly related to one another and manifest similar nomological networks. Although the vulnerable dark triad members are related to negative emotionality and antagonistic interpersonal styles, they are also related to introversion and disinhibition. According to both research and theory, persons who are highly affected by the Dark Triad are influenced by external, controllable factors.

On the contrary, those who are high in the Vulnerable Dark Triad (VDT) are driven by internal, embedded desires. Psychopathy and narcissism both have their clinical counterparts recognised by psychiatrists, known as Narcissistic Personality Disorder (or NPD) and Antisocial Personality Disorder (or ASPD). Given the dimensional model of narcissism and psychopathy, these traits are present at the subclinical level, which is a less severe form of clinical narcissism and psychopathy.

Personality Disorders

Being able to predict people's offset responses is essential, not only can save you a lot of time and trouble but can help substanciate projection and thus be beneficial to those who could really use a little understanding.

Psychologist Theodore Millon, who has written numerous popular works on personality, proposed the following description of personality disorders:

Type of personality disorder Description
Paranoid Guarded, defensive, distrustful and suspicious. Hypervigilant to the motives of others to undermine or do harm. Always seeking confirmatory evidence of hidden schemes. Feel righteous, but persecuted. Experience a pattern of pervasive distrust and suspicion of others that lasts a long time. They are generally difficult to work with and are very hard to form relationships with. They are also known to be somewhat short-tempered.
Schizoid Apathetic, indifferent, remote, solitary, distant, humorless, contempt, odd fantasies. Neither desire nor need human attachments. Withdrawn from relationships and prefer to be alone. Little interest in others, often seen as a loner. Minimal awareness of the feelings of themselves or others. Few drives or ambitions, if any. Is an uncommon condition in which people avoid social activities and consistently shy away from interaction with others. It affects more males than females. To others, they may appear somewhat dull or humorless. Because they don't tend to show emotion, they may appear as though they don't care about what's going on around them.
Schizotypal Eccentric, self-estranged, bizarre, absent. Exhibit peculiar mannerisms and behaviors. Think they can read thoughts of others. Preoccupied with odd daydreams and beliefs. Blur line between reality and fantasy. Magical thinking and strange beliefs. People with schizotypal personality disorder are often described as odd or eccentric and usually have few, if any, close relationships. They think others think negatively of them.
Antisocial Impulsive, irresponsible, deviant, unruly. Act without due consideration. Meet social obligations only when self-serving. Disrespect societal customs, rules, and standards. See themselves as free and independent. People with antisocial personality disorder depict a long pattern of disregard for other people's rights. They often cross the line and violate these rights.
Borderline Unpredictable, egocentric, emotionally unstable. Frantically fears abandonment and isolation. Experience rapidly fluctuating moods. Shift rapidly between loving and hating. See themselves and others alternatively as all-good and all-bad. Unstable and frequently changing moods. People with borderline personality disorder have a pervasive pattern of instability in interpersonal relationships.
Histrionic Hysteria, dramatic, seductive, shallow, egocentric, attention-seeking, vain. Overreact to minor events. Exhibitionistic as a means of securing attention and favors. See themselves as attractive and charming. Constantly seeking others' attention. Disorder is characterised by constant attention-seeking, emotional overreaction, and suggestibility. Their tendency to over-dramatise may impair relationships and lead to depression, but they are often high-functioning.
Narcissistic Egotistical, arrogant, grandiose, insouciant. Preoccupied with fantasies of success, beauty, or achievement. See themselves as admirable and superior, and therefore entitled to special treatment. Is a mental disorder in which people have an inflated sense of their own importance and a deep need for admiration. Those with narcissistic personality disorder believe that they're superior to others and have little regard for other people's feelings.
Avoidant Hesitant, self-conscious, embarrassed, anxious. Tense in social situations due to fear of rejection. Plagued by constant performance anxiety. See themselves as inept, inferior, or unappealing. They experience long-standing feelings of inadequacy and are very sensitive of what others think about them.
Dependent Helpless, incompetent, submissive, immature. Withdrawn from adult responsibilities. See themselves as weak or fragile. Seek constant reassurance from stronger figures. They have the need to be taken care of by a person. They fear being abandoned or separated from important people in their life.
Obsessive–compulsive Restrained, conscientious, respectful, rigid. Maintain a rule-bound lifestyle. Adhere closely to social conventions. See the world in terms of regulations and hierarchies. See themselves as devoted, reliable, efficient, and productive.
Depressive Somber, discouraged, pessimistic, brooding, fatalistic. Present themselves as vulnerable and abandoned. Feel valueless, guilty, and impotent. Judge themselves as worthy only of criticism and contempt. Hopeless, suicidal, restless. This disorder can lead to aggressive acts and hallucinations.
Passive–aggressive (Negativistic) Resentful, contrary, skeptical, discontented. Resist fulfilling others’ expectations. Deliberately inefficient. Vent anger indirectly by undermining others’ goals. Alternately moody and irritable, then sullen and withdrawn. Withhold emotions. Will not communicate when there is something problematic to discuss.
Sadistic Explosively hostile, abrasive, cruel, dogmatic. Liable to sudden outbursts of rage. Gain satisfaction through dominating, intimidating and humiliating others. They are opinionated and closed-minded. Enjoy performing brutal acts on others. Find pleasure in abusing others. Would likely engage in a sadomasochist relationship, but will not play the role of a masochist.
Self-defeating (Masochistic) Deferential, pleasure-phobic, servile, blameful, self-effacing. Encourage others to take advantage of them. Deliberately defeat own achievements. Seek condemning or mistreatful partners. They are suspicious of people who treat them well. Would likely engage in a sadomasochist relationship.

In addition to classifying by category and cluster, it is possible to classify personality disorders using additional factors such as severity, impact on social functioning, and attribution. This involves both the notion of personality difficulty as a measure of subthreshold scores for personality disorder using standard interviews and the evidence that those with the most severe personality disorders demonstrate a “ripple effect” of personality disturbance across the whole range of mental disorders.

In addition to subthreshold (personality difficulty) and single cluster (simple personality disorder), this also derives complex or diffuse personality disorder (two or more clusters of personality disorder present) and can also derive severe personality disorder for those of greatest risk.

Level of Severity Description Definition by Categorical System
0 No Personality Disorder Does not meet actual or subthreshold criteria for any personality disorder.
1 Personality Difficulty Meets sub-threshold criteria for one or several personality disorder.
2 Simple Personality Disorder Meets actual criteria for one or more personality disorders within the same cluster.
3 Complex (Diffuse) Personality Disorder Meets actual criteria for one or more personality disorders within more than one cluster.
4 Severe Personality Disorder Meets criteria for creation of severe disruption to both individual and to many in society.

There are several advantages to classifying personality disorder by severity:

Currently, there are no definitive proven causes for personality disorders. However, there are numerous possible causes and known risk factors supported by scientific research that vary depending on the disorder, the individual, and the circumstance. Overall, findings show that genetic disposition and life experiences, such as trauma and abuse, play a key role in the development of personality disorders.

Borderline personality disorder

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterised by a long-term pattern of unstable interpersonal relationships, distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behaviors, often due to their difficulty with returning their emotional level to a healthy or normal baseline. They may also struggle with a feeling of emptiness, fear of abandonment, and detachment from reality.

Descriptions and illustrations of Borderline Personality Disorder. Interviews with patients in group therapy describe thought, feelings, and subsequent behaviors.

Symptoms of BPD may be triggered by events considered normal to others. BPD typically begins by early adulthood and occurs across a variety of situations. Substance use disorders, depression, and eating disorders are commonly associated with BPD. Approximately 10% of people affected with the disorder die by suicide. The disorder is often stigmatised in both the media and the psychiatric field and as a result is often underdiagnosed. The causes of BPD are unclear but seem to involve genetic, neurological, environmental, and social factors. It occurs about five times more often in a person who has an affected close relative. Adverse life events appear to also play a role.

About 1.6% of people have BPD in a given year, with some estimates as high as 6%. Women are diagnosed about three times as often as men. The disorder appears to become less common among older people. Up to half of those with BPD improve over a ten-year period. Those affected typically use a high amount of healthcare resources. There is an ongoing debate about the naming of the disorder, especially the suitability of the word borderline.

Overall, the most distinguishing symptoms of BPD are pervasive patterns of instability in interpersonal relationships and self-image, alternating between extremes of idealisation and devaluation of others, along with varying moods and difficulty regulating strong emotional reactions. Dangerous or impulsive behavior is also correlated with the disorder. Other symptoms may include feeling unsure of one's identity, morals, and values; having paranoid thoughts when feeling stressed; depersonalisation; and, in moderate to severe cases, stress-induced breaks with reality or psychotic episodes.

Individuals with BPD often have comorbid conditions, such as depressive and bipolar disorders, substance use disorders, eating disorders, post-traumatic stress disorder, and attention-deficit/hyperactivity disorder.

Subtype Features
Discouraged borderline (including avoidant and dependent features) Pliant, submissive, loyal, humble; feels vulnerable and in constant jeopardy; feels hopeless, depressed, helpless, and powerless.
Petulant borderline (including negativistic features) Negativistic, impatient, restless, as well as stubborn, defiant, sullen, pessimistic, and resentful; easily feels "slighted" and quickly disillusioned.
Impulsive borderline (including histrionic or antisocial features) Captivating, capricious, superficial, flighty, distractable, frenetic, and seductive; fearing loss, the individual becomes agitated; gloomy and irritable; and potentially suicidal.
Self-destructive borderline (including depressive or masochistic features) Inward-turning, intropunitive (self-punishing), angry; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possible suicide.

Long-term psychotherapy is currently the treatment of choice for BPD. While psychotherapy, in particular Dialectical behavior therapy (DBT) and psychodynamic approaches, is effective, the effects are slow: many people have to put in years of work to be effective. More rigorous treatments are not substantially better than less rigorous treatments. There are six such treatments available: dynamic deconstructive psychotherapy (DDP), Mentalisation-based treatment (MBT), transference-focused psychotherapy, dialectical behavior therapy (DBT), general psychiatric management, and schema-focused therapy. Long-term therapy of any kind is better than no treatment, especially in reducing urges to self-injure.

Cognitive behavioral therapy (CBT) is also a type of psychotherapy used for treatment of BPD. This type of therapy relies on changing people's behaviors and beliefs by identifying problems from the disorder. CBT is known to reduce some anxiety and mood symptoms as well as reduce suicidal thoughts and self-harming behaviors. Some research indicates that mindfulness meditation may bring about favorable structural changes in the brain, including changes in brain structures that are associated with BPD. Mindfulness-based interventions also appear to bring about an improvement in symptoms characteristic of BPD, and some clients who underwent mindfulness-based treatment no longer met a minimum of five of the DSM-IV-TR diagnostic criteria for BPD.

The features of BPD include emotional instability; intense, unstable interpersonal relationships; a need for intimacy; and a fear of rejection. As a result, people with BPD often evoke intense emotions in those around them. Pejorative terms to describe people with BPD, such as "difficult", "treatment resistant", "manipulative", "demanding", and "attention seeking", are often used and may become a self-fulfilling prophecy, as the negative treatment of these individuals triggers further self-destructive behavior.

Schizotypal personality disorder

Schizotypal personality disorder (STPD), also known as schizotypal disorder, is a mental and behavioural disorder. DSM classification describes the disorder specifically as a personality disorder characterised by thought disorder, paranoia, a characteristic form of social anxiety, derealisation, transient psychosis, and unconventional beliefs. People with this disorder feel pronounced discomfort in forming and maintaining social connections with other people, primarily due to the belief that other people harbour negative thoughts and views about them.

There is now evidence to suggest that parenting styles, early separation, trauma/maltreatment history (especially early childhood neglect) can lead to the development of schizotypal traits. Neglect or abuse, trauma, or family dysfunction during childhood may increase the risk of developing schizotypal personality disorder. Over time, children learn to interpret social cues and respond appropriately but for unknown reasons this process does not work well for people with this disorder.

This is a disorder characterised by eccentric behavior and anomalies of thinking and affect which resemble those seen in schizophrenia, though no definite and characteristic schizophrenic anomalies have occurred at any stage. There is no dominant or typical disturbance, but any of the following may be present:

The disorder runs a chronic course with fluctuations of intensity. Occasionally it evolves into overt schizophrenia. There is no definite onset and its evolution and course are usually those of a personality disorder. It is more common in individuals related to people with schizophrenia and is believed to be part of the genetic "spectrum" of schizophrenia.

Theodore Millon proposes two subtypes of schizotypal personality. Any individual with schizotypal personality disorder may exhibit either one of the following somewhat different subtypes (Note that Millon believes it is rare for a personality with one pure variant, but rather a mixture of one major variant with one or more secondary variants):

Subtype Description Personality traits
Insipid schizotypal A structural exaggeration of the passive-detached pattern. It includes schizoid, depressive and dependent features. Sense of strangeness and nonbeing; overtly drab, sluggish, inexpressive; internally bland, barren, indifferent, and insensitive; obscured, vague, and tangential thoughts.
Timorous schizotypal A structural exaggeration of the active-detached pattern. It includes avoidant and negativistic features. Warily apprehensive, watchful, suspicious, guarded, shrinking, deadens excess sensitivity; alienated from self and others; intentionally blocks, reverses, or disqualifies own thoughts.

According to Theodore Millon, the schizotypal is one of the easiest personality disorders to identify but one of the most difficult to treat with psychotherapy. Persons with STPD usually consider themselves to be simply eccentric or nonconformist; the degree to which they consider their social nonconformity a problem and the degree to which psychiatry does differ. It is difficult to gain rapport with people who suffer from STPD due to the fact that increasing familiarity and intimacy usually increase their level of anxiety and discomfort.

Group therapy is recommended for persons with STPD only if the group is well structured and supportive. Otherwise, it could lead to loose and tangential ideation. Support is especially important for schizotypal patients with predominant paranoid symptoms, because they will have a lot of difficulties even in highly structured groups.

Reported prevalence of STPD in community studies ranges from 0.6% in a Norwegian sample, to 4.6% in an American sample. A large American study found a lifetime prevalence of 3.9%, with somewhat higher rates among men (4.2%) than women (3.7%). It may be uncommon in clinical populations, with reported rates of up to 1.9%.

Together with other cluster A personality disorders, it is also very common among homeless people who show up at drop-in centres [Jesus in the Slum ritualised abuses], according to a 2008 New York study. The study did not address homeless people who do not show up at drop-in centres.

Antisocial personality disorder

Antisocial personality disorder (ASPD or infrequently APD) is a personality disorder characterised by a long-term pattern of disregard for, or violation of, the rights of others as well as a difficulty sustaining long-term relationships. A weak or nonexistent conscience is often apparent, as well as a history of rule-breaking that can sometimes lead to law-breaking, a tendency towards substance abuse, and impulsive and aggressive behaviour. Antisocial behaviors often have their onset before the age of 8, and in nearly 80% of ASPD cases, the subject will develop their first symptoms by age 11. The Prevalence of ASPD peaks in people age 24 to 44 years old, and often decreases in people age 45 to 64 years. In the United States, the rate of antisocial personality disorder in the general population is estimated between 0.5 and 3.5 percent.

This is an actor portrayal of a patient with Antisocial personality disorder.

Antisocial personality disorder is defined by a pervasive and persistent disregard for morals, social norms, and the rights and feelings of others. Although behaviors vary in degree, individuals with this personality disorder will typically have limited compunction in exploiting others in harmful ways for their own gain or pleasure, and frequently manipulate and deceive other people. While some do so through a façade of superficial charm, others do so through intimidation and violence. They may display arrogance, think lowly and negatively of others, and lack remorse for their harmful actions and have a callous attitude towards those they have harmed. Irresponsibility is a core characteristic of this disorder; most have significant difficulties in maintaining stable employment as well as fulfilling their social and financial obligations, and people with this disorder often lead exploitative, unlawful, or parasitic lifestyles.

Those with antisocial personality disorder are often impulsive and reckless, failing to consider or disregarding the consequences of their actions. They may repeatedly disregard and jeopardise their own safety and the safety of others, which can place both themselves and other people in danger. They are often aggressive and hostile, with poorly regulated tempers, and can lash out violently with provocation or frustration. Individuals are prone to substance use disorders and addiction, and the non-medical use of various psychoactive substances is common in this population. These behaviors can in some instances lead such individuals into frequent conflict with the law, and many people with ASPD have extensive histories of antisocial behavior and criminal infractions stemming back to adolescence or childhood.

Antisocial personality disorder is characterised by at least 3 of the following:

Theodore Millon suggested 5 subtypes of ASPD. However, these constructs are not recognised in the DSM and ICD.

Subtype Features
Nomadic antisocial (including schizoid and avoidant features) Drifters; roamers, vagrants; adventurer, itinerant vagabonds, tramps, wanderers; they typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility.
Malevolent antisocial (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals, including serial killers.
Covetous antisocial (including negativistic features) Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having.
Risk-taking antisocial (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures.
Reputation-defending antisocial (including narcissistic features) Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights.

Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk-taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special ... Taxonomies may be put forward at levels that are more coarse or more fine-grained."

ASPD is considered to be among the most difficult personality disorders to treat. Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts.

They may only simulate remorse rather than truly commit to change: they can be seductively charming and dishonest, and may manipulate staff and fellow patients during treatment. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated. Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions.

Psychotherapy also known as talk therapy is found to help treat patients with ASPD. Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of Multisystemic therapy (MST) that could potentially improve this imperative issue. Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes.

Boys are twice as likely to meet all of the diagnostic criteria for ASPD than girls (40% versus 25%) and they will often start showing symptoms of the disorder much earlier in life. Children that do not show symptoms of the disease through age 15 will not develop ASPD later in life. If adults exhibit milder symptoms of ASPD, it is likely that they never met the criteria for the disorder in their childhood and were consequently never diagnosed. Overall, symptoms of ASPD tend to peak in late-teens and early twenties, but can often reduce or improve through age 40.

ASPD is ultimately a lifelong disorder that has chronic consequences, though some of these can be moderated over time. There may be a high variability of the long-term outlook of antisocial personality disorder. The treatment of this disorder can be successful, but it entails unique difficulties. It is unlikely to see rapid change especially when the condition is severe. In fact, past studies revealed that remission rates were small, with up to only 31% rates of improvement instead of remittance.

Without proper treatment, individuals suffering with ASPD could lead a life that brings about harm to themselves or others. This can be detrimental to their families and careers. ASPD victims suffer from lack of interpersonal skills (e.g., lack of remorse, lack of empathy, lack of emotional-processing skills). As a result of the inability to create and maintain healthy relationships due to the lack of interpersonal skills, individuals with ASPD may find themselves in predicaments such as divorce, unemployment, homelessness and even premature death by suicide.

Histrionic personality disorder

Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterised by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive desire for approval. People diagnosed with the disorder are said to be lively, dramatic, vivacious, enthusiastic, extroverted and flirtatious. People with HPD have a high desire for attention, make loud and inappropriate appearances, exaggerate their behaviors and emotions, and crave stimulation. They may exhibit sexually provocative behavior, express strong emotions with an impressionistic style, and can be easily influenced by others. Associated features include egocentrism, self-indulgence, continuous longing for appreciation, and persistent manipulative behavior to achieve their own wants.

People with HPD are usually high-functioning, both socially and professionally. They usually have good social skills, despite tending to use them to manipulate others into making them the center of attention. HPD may also affect a person's social and romantic relationships, as well as their ability to cope with losses or failures. They may seek treatment for clinical depression when romantic (or other close personal) relationships end. Individuals with HPD often fail to see their own personal situation realistically, instead dramatising and exaggerating their difficulties. They may go through frequent job changes, as they become easily bored and may prefer withdrawing from frustration (instead of facing it). Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing clinical depression.

Additional characteristics may include:

Some people with histrionic traits or personality disorder change their seduction technique into a more maternal or paternal style as they age.

A mnemonic that can be used to remember the characteristics of histrionic personality disorder is shortened as "PRAISE ME"

Little research has been done to find evidence of what causes histrionic personality disorder. Although direct causes are inconclusive, various theories and studies suggest multiple possible causes, of a neurochemical, genetic, psychoanalytic, or environmental nature. Traits such as extravagance, vanity, and seductiveness of hysteria have similar qualities to women diagnosed with HPD. HPD symptoms typically do not fully develop until the age of 15, while the onset of treatment only occurs, on average, at approximately 40 years of age.

Theodore Millon identified six subtypes of histrionic personality disorder. Any individual histrionic may exhibit one or more of the following:

Subtype Description Personality Traits
Appeasing histrionic Including dependent and compulsive features Seeks to placate, mend, patch up, smooth over troubles; knack for settling differences, moderating tempers by yielding, compromising, conceding; sacrifices self for commendation; fruitlessly placates the unplacatable.
Vivacious histrionic The seductiveness of the histrionic mixed with the energy typical of hypomania. Some narcissistic features can also be present Vigorous, charming, bubbly, brisk, spirited, flippant, impulsive; seeks momentary cheerfulness and playful adventures; animated, energetic, ebullient.
Tempestuous histrionic Including negativistic features Impulsive, out of control; moody complaints, sulking; precipitous emotion, stormy, impassioned, easily wrought-up, periodically inflamed, turbulent.
Disingenuous histrionic Including antisocial features Underhanded, double-dealing, scheming, contriving, plotting, crafty, false-hearted; egocentric, insincere, deceitful, calculating, guileful.
Theatrical histrionic Variant of “pure” pattern Affected, mannered, put-on; postures are striking, eyecatching, graphic; markets self-appearance; is synthesised, stagy; simulates desirable/dramatic poses.
Infantile histrionic Including borderline features Labile, high-strung, volatile emotions; childlike hysteria and nascent pouting; demanding, overwrought; fastens and clutches to another; is excessively attached, hangs on, stays fused to and clinging.

Treatment is often prompted by depression associated with dissolved romantic relationships. Medication does little to affect the personality disorder, but may be helpful with symptoms such as depression Treatment for HPD itself involves psychotherapy, including cognitive therapy. Another way to treat histrionic personality disorder after identification is through functional analytic psychotherapy. The job of a Functional Analytic Psychotherapist is to identify the interpersonal problems with the patient as they happen in session or out of session. Initial goals of functional analytic psychotherapy are set by the therapist and include behaviors that fit the client's needs for improvement.

This personality is seen more often in women than in men. Approximately 65% of HPD diagnoses are women while 35% are men. Many symptoms representing HPD in the DSM are exaggerations of traditional feminine behaviors. In a peer and self-review study, it showed that femininity was correlated with histrionic, dependent and narcissistic personality disorders. Although two thirds of HPD diagnoses are female, there have been a few exceptions. Those with HPD are more likely to look for multiple people for attention, which leads to marital problems due to jealousy and lack of trust from the other party. This makes them more likely to become divorced or separated once married.

The prevalence of histrionic personality disorder in women is apparent and urges a re-evaluation of cultural notions of normal emotional behaviour. The diagnostic approach classifies histrionic personality disorder behaviour as “excessive”, considering it in reference to a social understanding of normal emotionality.

Narcissistic personality disorder

Narcissistic personality disorder is a mental disorder characterised by a life-long pattern of exaggerated feelings of self-importance, an excessive craving for admiration, and a diminished ability to empathise with other's feelings. These personality traits are often overcompensation for a fragile ego, an intolerance of criticism, and a weak sense of self. Narcissistic personality disorder differs from self-confidence which is associated with a strong sense of self.

People with NPD exaggerate their skills, accomplishments, and their degree of intimacy with people they consider high-status. Such a sense of personal superiority may cause them to monopolise conversations, or to become impatient and disdainful when other persons talk about themselves. This attitude connects to an overall worse functioning in areas of life like work and intimate romantic relationships.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5, 2013) describes NPD as possessing at least five of the following nine criteria.

  1. A grandiose sense of self-importance
  2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. Believing that they are "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
  4. Requiring excessive admiration
  5. A sense of entitlement (unreasonable expectations of especially favorable treatment or automatic compliance with their expectations)
  6. Being interpersonally exploitative (taking advantage of others to achieve their own ends)
  7. Lacking empathy (unwilling to recognise or identify with the feelings and needs of others)
  8. Often being envious of others or believing that others are envious of them
  9. Showing arrogant, haughty behaviors or attitudes

To the extent that people are pathologically narcissistic, the person with NPD can be a self-absorbed control freak who passes blame by psychological projection and is intolerant of contradictory views and opinions; is apathetic towards the emotional, mental, and psychological needs of other people; and is indifferent to the negative effects of their behaviors, whilst insisting that people should see them as an ideal person. To protect their fragile self-concept, narcissists use psychosocial strategies, such as the tendency to devalue and derogate and to insult and blame other people, usually with anger and hostility towards people's responses to the narcissist's anti-social conduct.

This is an actor portrayal of a patient with narcissistic personality disorder.

Narcissistic personalities are more likely to respond with anger or aggressiveness when presented with rejection. Because they are sensitive to perceived criticism or defeat, people with NPD are prone to feelings of shame, humiliation, and worthlessness over minor incidents of daily life and imagined, personal slights, and usually mask such feelings from people, either by way of feigned humility, or by responding with outbursts of rage and defiance, or by seeking revenge. The merging of the inflated self-concept and the actual self is evident in the grandiosity component of narcissistic personality disorder; also inherent to that psychological process are the defence mechanisms of idealisation and devaluation and of denial.

Theodore Millon suggested five subtypes of narcissist; however, there are few, pure subtypes of narcissist.

Environmental and social factors also exert significant influence upon the onset of NPD in a person. In some people, pathological narcissism may develop from an impaired emotional attachment to the primary caregivers, usually the parents. That lack of psychological and emotional attachment to a parental figure can result in the child's perception of themselves as unimportant and unconnected to other people, usually, family, community and society. Typically, the child comes to believe that they have a personality defect that makes them an unvalued and unwanted person; in that vein, either overindulgent and permissive parenting or insensitive and over-controlling parenting are contributing factors towards the development of NPD in a child.

In Gabbard's Treatments of Psychiatric Disorders (2014), the following factors are identified as promoting the development of narcissistic personality disorder:

Moreover, the research reported in "Modernity and Narcissistic Personality Disorders" (2014) indicates that cultural elements also influence the prevalence of NPD, because narcissistic personality traits more commonly occur in modern societies than in traditionalist conservative societies. The lifetime rates of narcissistic personality disorder are estimated at 1% in the general population; and between 2% and 16% in the clinical population. A 2010 metareview of 7 studies found that the mean prevalence of NPD was 1.06 in community samples, and that the yearly number of new cases of NPD in men is slightly greater than in women.

Avoidant personality disorder

Those affected display a pattern of severe social anxiety, social inhibition, feelings of inadequacy and inferiority, extreme sensitivity to negative evaluation and rejection, and avoidance of social interaction despite a strong desire for intimacy. People with AvPD often consider themselves to be socially inept or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked. They often avoid becoming involved with others unless they are certain they will be liked.

Childhood emotional neglect (in particular, the rejection of a child by one or both parents) and peer group rejection are associated with an increased risk for its development; however, it is possible for AvPD to occur without any notable history of abuse or neglect. Some with this disorder fantasise about idealised, accepting and affectionate relationships because of their desire to belong. They often feel themselves unworthy of the relationships they desire, and shame themselves from ever attempting to begin them.

If they do manage to form relationships, it is also common for them to preemptively abandon them out of fear of the relationship failing. Individuals with the disorder tend to describe themselves as uneasy, anxious, lonely, unwanted and isolated from others. They often choose jobs of isolation in which they do not have to interact with others regularly. Avoidant individuals also avoid performing activities in public spaces for fear of embarrassing themselves in front of others.

Symptoms include:

Causes of AvPD are not clearly defined, but appear to be influenced by a combination of social, genetic and psychological factors. The disorder may be related to temperamental factors that are inherited. Specifically, various anxiety disorders in childhood and adolescence have been associated with a temperament characterised by behavioral inhibition, including features of being shy, fearful and withdrawn in new situations.

These inherited characteristics may give an individual a genetic predisposition towards AvPD. Childhood emotional neglect and peer group rejection are both associated with an increased risk for the development of AvPD. Some researchers believe a combination of high-sensory-processing sensitivity coupled with adverse childhood experiences may heighten the risk of an individual developing AvPD.

Theodore Millon identified four adult subtypes of avoidant personality disorder.

Subtype and description Personality traits
Phobic avoidant (including dependent features) General apprehensiveness displaced with avoidable tangible precipitant; qualms and disquietude symbolised by a repugnant and specific dreadful object or circumstances.
Conflicted avoidant (including negativistic features) Internal discord and dissension; fears dependence; unsettled; unreconciled within self; hesitating, confused, tormented, paroxysmic, embittered; unresolvable angst.
Hypersensitive avoidant (including paranoid features) Intensely wary and suspicious; alternately panicky, terrified, edgy, and timorous, then thin-skinned, high-strung, petulant, and prickly.
Self-deserting avoidant (including depressive features) Blocks or fragments self-awareness; discards painful images and memories; casts away untenable thoughts and impulses; possibly jettisons self (suicidal).

In 1993, Lynn E. Alden and Martha J. Capreol proposed two other subtypes of avoidant personality disorder:

Subtype Features
Cold-avoidant Characterised by an inability to experience and express positive emotion towards others.
Exploitable-avoidant Characterised by an inability to express anger towards others or to resist coercion from others. May be at risk for abuse by others.

Treatment of avoidant personality disorder can employ various techniques, such as social skills training, psychotherapy, cognitive therapy, and exposure treatment to gradually increase social contacts, group therapy for practicing social skills, and sometimes drug therapy. A key issue in treatment is gaining and keeping the patient's trust since people with an avoidant personality disorder will often start to avoid treatment sessions if they distrust the therapist or fear rejection.

The primary purpose of both individual therapy and social skills group training is for individuals with an avoidant personality disorder to begin challenging their exaggerated negative beliefs about themselves. Significant improvement in the symptoms of personality disorders is possible, with the help of treatment and individual effort. Data from the 2001–02 National Epidemiologic Survey on Alcohol and Related Conditions indicates a prevalence of 2.36% in the American general population. It appears to occur with equal frequency in males and females. In one study, it was seen in 14.7% of psychiatric outpatients.