Personality disorders can create a distorted self-image.
by Anne R. Allen.
Most of the truly rotten villains in fiction are what used to be called “psychopaths.” (Now clinically known as people with ASPD: Anti-Social Personality Disorder.) These are people who have no conscience and no empathy.
But psychopaths can make boring fiction. Psychopathic villains have pretty uncomplicated motives. They’re usually sexually twisted sadists or conscience-free monsters who do evil things because they’re, well…evil.
And not all people with ASPD need to be villains. Benedict Cumberbatch’s version of Sherlock Holmes has the ASPD detachment from normal human emotions like guilt and empathy. Plenty of people with the disorder lead normal, non-criminal lives. Even a conscience-free person needs a reason to commit a crime.
But you can create more interesting antagonists if you give them more relatable personality disorders. We have all experienced some PD symptoms, at least early in our lives. All healthy toddlers are narcissists. And every young child has the fear of abandonment that fuels Borderline issues. Plus we’ve all had a few paranoid moments when it feels as if somebody’s out to get us or rejection is coming at us from everywhere. Especially if you’re a writer 🙂
A basic knowledge of personality disorders can help writers create more interesting heroes and supporting characters, too. One of the most memorable detectives in recent fiction was Adrian Monk of the TV show Monk, who suffered from Obsessive Compulsive Personality Disorder.
So what are personality disorders? They’re a constellation of behaviors that are generally problematic, but not debilitating. They do cause troubling consequences for the person dealing with them—and for those around them. Generally they don’t require hospitalization (with the exception of Borderline patients.)
Diagnostic and Statistical Manual of Mental Disorders
Personality disorders are defined by the Diagnostic and Statistical Manual of Mental Disorders, a publication of the American Psychiatric Society.
First published in 1952, the DSM has been revised five times, with major revisions to criteria for personality disorders. (The manual is not without controversy. It wasn’t until 1974 and DSM-3, that it stopped defining homosexuality as a mental disorder.)
The current DSM, published in 2000, is #5. It brought some big changes in thinking about personality disorders. According to Psychology Today, now a doctor will diagnose personality disorders when the patients have “significant impairments” due to behavior caused by the disorders. They need only display “one or more pathological personality traits.”
The DSM dictates that the symptoms of personality disorders must be:
- Consistent in all situations (not something that comes and goes with different interactions.)
- Not caused by the person’s situation or age. (We’re all narcissists when we’re two.)
- Not caused by drugs or alcohol or a physical disease like a brain tumor or Alzheimer’s.
DSM-5 lists 10 personality disorders, which are divided into three clusters.
Cluster A (Eccentric)
These people are driven by shame and are highly sensitive to rejection. People with PPD also have a strong sense of what they perceive to be their rights. They can bear fierce grudges against anyone they believe has violated their rights.
As a result, they can bear those grudges for life. (Good for antagonists or vigilante characters.)
People with this disorder are also very susceptible to projection—imagining that other people are having their own negative thoughts and feelings.
This doesn’t have anything to do with schizophrenia, and some psychologists argue it’s not a disorder at all. They believe this behavior is simply an expression of extreme sensitivity and a rich inner life.
The name comes from a person’s detachment from reality and obsession with their own thoughts and fantasies.
Although these people are often unable to form attachments because of their oddness, they don’t reject others and often long for normal intimacy.
These people can seem strange, but they generally cause no one harm and are usually hardworking, functioning members of society. (Some of them are known as “writers.”)
These people don’t trust others and often imagine strangers are conspiring to harm them. Some medical professionals believe this disorder can herald schizophrenia.
They are subject to irrational beliefs and magical thinking.
These are the “tinfoil hat” people who often think that outside phenomena and events have been orchestrated to harm them personally. They may think the alien mothership is sending down signals that make the traffic lights turn red just as they arrive at the intersection. Or that a government agency has them under surveillance for murky, bizarre reasons. These people are rarely dangerous, but their irrational fears can be very trying for family members and co-workers.
If you’re writing one of those unreliable narrator thrillers, a Schizotypal PD character might provide a fascinating voice. They are usually careful observers, but come to bizarre conclusions about what they observe.
Cluster B (Dramatic, Erratic)
With the exception of ASPD, people with Cluster B disorders have a desperate need to be the center of attention. They often can’t sit in a theater for more than a short performance of music, film, or live theater. They will find an excuse to leave or create a disruption because they’re miserable when attention is on something other than themselves.
The same is true in social situations. If someone else has the floor, they will often pick a fight or tell the speaker they’re wrong–only to “correct” the speaker with the identical statement–in order to draw attention.
This is the personality disorder most commonly associated with crime. People with ASPD are the most likely to have criminal records and a history of incarceration.
They are incapable of empathy or feelings of guilt. This means you’ll only make them angry if you ask them to “have a heart” or “remember the Golden Rule” They have no “heart”, and are incapable of imagining themselves in anybody else’s shoes.
Because of this, they don’t believe social rules and obligations apply to them. They can become irritable and aggressive when someone asks them to follow the rules. They never feel ashamed, so they usually don’t learn from experience and tend to commit the same offenses over and over.
Unlike the Cluster A people, the anti-social generally form relationships easily. They can be charming, but their relationships are usually short-lived and abusive.
The classic serial killers in fiction (and real life) have the characteristics of ASPD.
These people lack a sense of self and suffer feelings of emptiness and fear of abandonment. The disorder is characterized by wildly unstable emotions and relationships.
Borderline people don’t know who they are unless they have someone to mirror them, which means they’re terrified of being alone. This can lead to substance abuse, sex addiction, depression, and eating disorders.
The designation “Borderline” came from early perceptions of the disease, when the medical profession saw the disorder as something between psychosis and neurosis—on the “borderline.” That’s not accurate, but when it was recognized as a personality disorder in 1980, the misnomer stuck.
Like the Harmoniums in Vonnegut’s Sirens of Titan, BPD people spend their lives saying, “Here I am!”—always looking for people to say, “There you are!” But if somebody says “Here I am!” instead, a BPD person can burst into rage.
They’re not able to sustain interest in other people except to boost their own self-worth. For that reason, they seek out either high-status people or “good listeners” who never express needs of their own.
Because of their inability to reciprocate friendship, they tend to “take hostages” rather than make real friends.
They often use threats of suicide to control people around them, and have a pattern of intense, highly volatile relationships. They’re prone to outbursts of violent rage, mood swings, and wildly impulsive—usually self-destructive—behavior.
The character of Alistair Milbourne in my novel The Gatsby Game was based on a real person, David Whiting, who suffered a mysterious death in a famous Hollywood scandal. I knew David and I think now that he had Borderline Personality Disorder. He was desperate to “belong” but he never could. His father was a mysterious stranger who never acknowledged him, and his mother abandoned him in boarding schools from the time he was six.
The Histrionic person lacks a sense of self-worth and depends on the constant approval of others.
These are people who are always “on” and seem to over-dramatize every event in their lives. Every little slight or perceived show of disrespect can trigger reactions of operatic proportions.
They tend to fetishize minor events in their lives and expect others to do the same. They may expect the entire family to wear black on the anniversary of the death of their beloved parakeet, or go into a rage if everyone in the office doesn’t buy their self-published poetry chapbook.
If a HPD person loves red roses, then red roses will take on an almost religious significance. People who give her red roses will automatically be seen as trustworthy, honest and kind.
But if the lying ex of the HPD gave her white roses, even a mention of white roses will send her into high dudgeon. Or like the Queen of Hearts in Alice in Wonderland, she may expect you to paint the white roses in your garden red.
The Queen of Hearts is a great example of a histrionic character. In fact, most of the characters in the Alice books could represent some kind of personality disorder.
“Histrionic” is derived from the Latin word histrionicus, meaning “pertaining to the actor.” No, it doesn’t come from the Greek word hystera, meaning “uterus” as you may have read. And histrionic people are not considered “hysterical”—a misogynist word that does come from the Greek “hystera”.
But lots of HPDs find a home in the theater, or in sales positions where putting on a dramatic persona is useful..
They can live in a vicious circle where the more rejected they feel, the more histrionic they become — and the more histrionic they become, the more rejected they feel.
This is the personality disorder we hear most about. These people have an extreme sense of entitlement and a pathological need to be admired and control others.
They are fiercely envious and expect other people to envy them.
Like people with Anti-Social Personality Disorder, they lack empathy. They lie and cheat and exploit others to achieve their aims and are prone to irrational rages.
But unlike people with ASPD, they do feel shame and guilt, and will go to great lengths to cover up things that embarrass them. They are highly critical of others but can tolerate no criticism of themselves.
There are only two people in the life of a person with NPD: Me and Not-Me. So if Mr. NPD tells something to his secretary, he expects his wife to know what he said—even if she wasn’t there—because both people are “Not-Me.” This is why narcissists go into rages when people can’t “read their minds.”
They can also be very charming and charismatic as they draw potential minions into their web. Narcissism is dangerous—but it’s less dangerous to the narcissist than it is to the people around them–so they are the least likely to seek help.
Narcissists make recognizable villains for your fiction, because everybody has had to deal with one at some point in their lives. Most of us still carry the wounds if we’ve ever run into a Malignant Narcissist (a combination of ASPD and NPD.)
But narcissists can be endearingly childlike. And funny. Many sitcom characters are classic narcissists. Frasier Crane, Karen Walker in Will and Grace and Titus Andromedon in the Unbreakable Kimmy Schmidt are all endearing narcissists.
Cluster C (Anxious, Fearful)
People with avoidant personality disorders believe that they are unappealing, inferior, and socially incompetent. The constant fear of being embarrassed, criticized, or rejected drives all their actions.
Because this can make them socially awkward, they can go to great lengths to avoid social situations. They also may self-sabotage to avoid any kind of success that might put them in the spotlight.
They often reject people who are kind to them in order to reject before it happens to them.
An abusive level of criticism in childhood may be one of the causes of the disorder
These people lack self-confidence and have an inability to make mature decisions. They demand that other people—-sometimes complete strangers—make decisions for them.
But they will turn on those people if the decisions have negative consequences. They can’t take responsibility for their actions so they need to have somebody to blame for their failures.
This means they can’t learn or grow. We all learn from our failures, so people who can’t allow themselves to fail can’t grow up.
Dependent issues can lead to the personality disorders of Cluster B. People with DPD crave attention the way a small child does. So their symptoms can mimic the childish behaviors of NPD or BPD.
Obsessive-compulsive (Anankastic) PD:
These people suffer from extreme perfectionism, which can be paralyzing. They’re obsessed with details, rules, lists, organization, or schedules. They often need to repeat ritualistic actions.
Sometimes they’re germphobic and obsessed with cleanliness. They can also be hoarders and very stingy with money. The classic miser character sitting alone and counting his money is typical of someone with OCPD.
All of this comes from a need to control a universe that feels disordered and chaotic to them.
OCPD is not the same as Obsessive-Compulsive Disorder (OCD) although the two have many similar characteristics. OCD is an anxiety disorder, not a personality disorder. People with OCPD don’t repeat ritualistic acts. Also, they usually enjoy their actions, rather than feel guilty, like people with OCD.
OCPD also mimics some symptoms of Asperger’s syndrome, and people on the autism spectrum are more likely to have OCPD than the general population.
All of these disorders exist on a spectrum, and people can have a mild version of a disorder and function normally. But substance abuse, trauma, or disease can intensify the disorder.
For instance, Adrian Monk’s OCPD increased exponentially after his wife was murdered in front of him in a seemingly senseless act—increasing his dread of chaos.
People with one personality disorder will often show characteristics of another—especially in the same cluster.
There’s disagreement in the mental health field about how many people have personality disorders. For a number of years some psychologists argued it could be as many as 1 in 5. But a 2006 UK study put the number more at 1 in 20.
Personality disorders can’t be cured, but they can be controlled with medication and talk therapy. They also usually improve with age. (Except for the people with schizotypal PD who later develop schizophrenia. )
Mental health experts don’t agree on the causes of personality disorders. Some disorders appear to be genetic, and others seem more likely caused by childhood abuse or trauma. Many are cases of arrested development, where people’s personalities simply didn’t mature along with their bodies.
But I think we can agree that studying up on them will help us understand our fellow humans—and write about them more effectively.
by Anne R. Allen (@annerallen) August 5, 2018
Those of us who studied psych. in college several decades ago didn’t learn this stuff because a lot of these definitions are relatively new. Did you know all the kinds of personality disorders? Have you written about characters who have any of these disorders?
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