Personality Disorders in the Paranoid-Narcissistic Spectrum
by Dr. T. O'Connor, Dept of Justice Studies, NC Wesleyan College
There are ten different personality disorders, and in this lecture, the spectrum approach is followed which allows for mixed types, and it should be noted the spectrum approach is controversial and not the way most clinical psychologists are trained. The spectrum approach to classification transcends the DSM (Diagnostic Statistical Manual) method, and is essentially a heuristic approach designed for theory development, not validation.
No single set of symptoms are required for inclusion in a spectrum. Rather, the sameness or similarity of comorbidity characteristics and the underlying causal processes are looked at. Spectra can be constructed that link Axis I and Axis II disorders, psychotic disorders and personality disorders, affective disorders and sexual disorders, and so on. In most cases, the subject's personality has not disintegrated to the point where there is any one identifiable clinical syndrome. A spectrum disorder may exist in muted form or as a mirror-image of a diagnosed or undiagnosed mental illness. We are concerned in this lecture with personality types that primarily exhibit the common characteristic of aggression.
Paranoia occurs in two forms: (1) the "bad me" paranoid; and (2) the "poor me" paranoid. Paranoia affects .5 to 2.5% of the population.
The "bad me" type tends to be more rageful and sadistic than the other type. Paranoia in all its forms tends to be organized around aggression, from sadomasochistic violence to lingering hostile mood. Paranoia is an insidious disease which develops slowly as a secondary personality characteristic, fuses into a more or less dysfunctional coping style, and may or may not become the dominant pattern. Psychologists suspect that the cause of paranoia is found in the mothering experience, in particular, the breast-feeding experience. Successfully breast-fed infants develop the capacity to feel supported and a tolerance for frustration. Unsuccessfully breast-fed infants (those who viewed the experience as "bad" in some way) develop a distinct inability to experience self-satisfaction, tolerance, and positive relationships. Internalization of the bad experience leads to the initiation of provocative and confirmatory interactions with others, mostly through splitting (seeing things as black-white, good-bad, weak-strong) and projection (accusing others of having the disowned aspects of your self).
A full-blown "bad me" paranoid perceives threats in everything other people do, often exploding in manic, counterphobic episodes. A full-blown "poor me" type views the world as basically unfair and persecutory, countering their anticipation of discomfort with either antisocial behavior or grandiosity.
Delusions: One the cardinal symptoms of paranoia and other disorders, most notably schizophrenia. Delusions are faulty interpretation of reality that cannot be shaken despite clear evidence to the contrary.
Delusions can be classified as:
- Bizarre -- belief that others can hear your thoughts, others are inserting thoughts, or your thoughts, feelings, and impulses are controlled by an external force
- Referential -- belief that certain gestures, comments, song lyrics, or passages in printed material are specifically intended for you or reference you in some way
- Grandiose -- belief that you are an extremely important person, an invaluable member of society, and possess or make some special unrecognized talent or contribution
- Persecution -- belief that others are out to get you, are plotting against you, foiling your every move, or making you feel guilty or ashamed
- Bodily -- belief in some kind of undiagnosed deteriorative medical condition such as dissolving of spinal cord, rotting or deterioration of skin, organs, or brain
- Religious -- belief that you are an important religious figure, in contact with deities, or serving some special theological purpose in the world.
Narcissism is a somewhat less severe form of psychopathy.
It manifests aggressive, paranoid, and borderline characteristics, but more commonly appears in the form of envy, greed, power lust, an extensively rationalized sense of entitlement, and a pathological grandiose self. Unlike psychopaths, narcissists can experience loyalty and guilt; but like psychopaths, narcissists lack empathy or caring for others, viewing people as "playthings" to be used.
Female narcissists tend to be the kind that "sleep" their way to the top; male narcissists tend to get ahead by becoming involved in massive power struggles. Psychologists suspect that the cause of narcissism is severe mental or physical pain in childhood at the hands of a powerful, idealized mother-father figure. Inconsistent parental attitudes on aggression and self-assertion as well as childhood experiences of being valued for specific, precocious talents seem to be the prime determinants. They never learned who to identify with -- the aggressor or victim, and they developed a pragmatic philosophy of siding with winners, regardless of who was in the right or wrong. In fact, they believe that the "good" is usually changeable and fickle while "bad" is stable and predictable. They live life by idealizing those who satisfy their narcissistic needs and systematically devaluing and denigrating those who do not. Underneath their superficial charm, they feel they have a right to control, manipulate, exploit, and be cruel to others.
There's not much research proving narcissists are more prone to violence than any other group, and no one has a clue as to how widespread this particular personality disorder is - estimates range between 3 and 15% of the population, with 5-7% being a fair estimate. Being a narcissist is close to being an alcoholic but MUCH more so. Alcoholism is impulsive behavior. Narcissists have this plus hundreds of other problems. Narcissists frequently have uncontrollable behaviors, like rage which is an outcome of their grandiosity. Narcissists can rarely be cured, but side effects, associated disorders (such as OCD), pathological lying, and the paranoiac dimensions CAN be modified.
ANGER, WORRY, RAGE
Most Personality Disordered people are prone to anger. Their bottled-up anger is always sudden, raging, frightening and without apparent provocation by an outside agent. It would seem that people suffering from personality disorders are in a CONSTANT state of anger, which is effectively suppressed most of the time. It manifests itself only when the person's defenses are down, incapacitated, or adversely affected by circumstances, inner or external. In a nutshell, such people were usually unable to express anger at "forbidden" targets in their early, formative years (parents, in most cases). The anger, however, was a justified reaction to very real abuse or mistreatment. The patient was, therefore, left to nurture a sense of profound injustice and frustrated rage. Healthy people experience anger, but as a transitory state.
- Personality disordered anger is always acute and permanently present.
- Healthy anger has an external inducing agent (a reason), and is directed at another (coherence).
- Pathological anger is neither coherent, nor externally induced. It emanates from the inside and is diffuse, directed at the "world" or "injustice" in general.
The Personality Disordered are afraid to show that they are angry to meaningful others because they are afraid to lose them. The Borderline Personality Disordered is terrified of being abandoned, the Narcissist needs his Narcissistic supply sources, the Paranoid - his persecutors and so on. These people prefer to direct their anger at people who are meaningless to them, people whose withdrawal will not constitute a threat to their precariously balanced personality. They will yell at a waitress, shout at a taxi driver, or explode at an underling. Alternatively, they will sulk, feel bored, drink or do drugs ? all forms of self-directed aggression. From time to time, no longer able to pretend and to suppress, they will have it out with the real source of their anger. They will rage and, generally, behave like lunatics. They will shout incoherently, make absurd accusations, distort facts, pronounceallegations and suspicions. These episodes will be followed by periods of sentimental sweetness and excessive flattering and submissiveness towards the victim of the latest rage attack. Motivated by the mortal fear of being abandoned or ignored, the Personality Disordered will debase and demean himself to the point of provoking repulsion in the beholder. These pendulum-like emotional swings are common. Anger is the reaction to injustice (perceived injustice, it does not have to be real), to disagreements, to inconvenience.
Hostile expressions by the Personality Disordered are not constructive - they are destructive because they are diffuse, excessive, and unclear. They do not lash out at people in order to restore self-esteem, prestige, or a sense of power and control, but because they cannot help it and are in a self destructive and self-loathing mode. Their angry episodes contain few signals or warning signs. Their anger is primitive, maladaptive, and pent up.
The Personality Disordered also suffer from a cognitive deficit. They are unable to conceptualize, to design effective strategies and to execute them. They dedicate all their attention to the immediate and ignore the future consequences of their actions. In other words, their attention and information processing faculties are distorted, skewed in favor of the here and now, biased on both the intake and the output. Time is dilated for them - the present feels more protracted, "longer" than any future. Immediate facts and actions are judged more relevant and weighted more heavily than any remote aversive conditions. Anger impairs cognition. The angry person is a worried person.
The Personality Disordered is also excessively preoccupied with himself (solipsism). Worry and anger are the cornerstones of anxiety. The striking similarity between anger and personality disorders is the deterioration of the faculty of empathy. Angry people cannot empathize. Actually, "counter-empathy" develops. Recent provocative acts by others are judged to be more serious ? just by "virtue" of their chronological position. This is what distinguishes rage from anger.
Rage attacks in personality disorders are always incommensurate with the magnitude of the source. Anger is usually a reaction to an ACCUMULATION of aversive experiences, all enhancing each other in vicious feedback loops, many of them not directly related to the cause of the specific anger. The angry person may be reacting to stress, agitation, disturbance, drugs, violence or aggression witnessed by him, to social or to national conflict, to elation and even to sexual excitation.
EVIL, DESTRUCTIVENESS, ADDICTION
The psychopathic argument with reality that is present in all personality disorders is a narcissistic pleasure of lying and deception. They don't lie to everybody, only those people (good-bad, strong-weak, females, strangers, authority figures) that they have differentiated as worthwhile or not. Each dichotomous split and pattern of lying is indicative of a different personality disorder, but the most common pattern is a desire to dupe or deceive those perceived as "good" people, to rob them of their "goodness", as it were, and to further deprive them of any moral right to feel victimized. Identification is always with the aggressor or with evil -- as powerful, bad, and ideal. In many cases, there are fantasies or interests about animal predators or archetypal evil demigods.
An inverted conscience means that the superego idealizes evil. Things that would normally produce guilt, insecurity, and anticipation of punishment in ordinary people produce feelings of self-esteem, security, and self-cohesion in the personality disordered. They only experience a sense of being true to their real self when they are persecuting others, inducing pain and suffering, and further experiencing feedback about how much malicious destruction they have done. Full-blown psychopaths have the highest degree of inverted conscience, and sadists have the highest degree of need for feedback.
However, it's extremely rare to find a perfectly intact inverted conscience. Most of the personality disordered live with fragments of a normal superego. These guilt fragments are expressed in occasional self-defeating behaviors. Their self-destructiveness will probably never take the form of suicide or any devaluing of the importance of winning through aggression, but they may change their split between strong-weak attributions, present themselves for therapy, or seek out religious mysticism. More frequently, however, when confronted with a self-crisis, they will adopt new names (aliases) for themselves, thus making themselves their own parents.
Drugs and alcohol are used to repair their personalities especially when there is a problematic representation of self to others. The personality disordered are commonly addicted persons because the "cycle of addiction" perpetuates the extreme self-state needed to shore up their self-cohesion while at the same time undermining any adaptive integration of self with experience. All addicted persons experience cycles of self-state extremes. One of the extreme self-states will be the dominant organizer of experience. An alcohol-induced self-state, for example, will assist in lowering inhibitions and facilitating aggressive tendencies. A psychoactive drug-induced self-state may assist in fostering paranoid delusions. The most serious and sadistic crimes committed by such individuals will be when they are at the peak of their dominant extreme self-state. This means that they commit crime while intoxicated or shortly thereafter. Since they only "need" to drink or drug when there is a need for personality repair, it's unclear if they have a substance addition, a violence addiction, or a state of mind addiction.
PERSONALITY DISORDERS IN THIS SPECTRUM
Aggressive Style:
PARANOID:
Provocative, pre-emptive attack
Superego Development: Defective
Conscience: Retributive, vindicates self
Destructiveness: Vengeful
NARCISSISTIC:
Denigrating, demeaning to others
Superego: Immature
Conscience: Normal with Delusions
Destructiveness: Interpersonal Exploitation
ANTISOCIAL:
Rebellious, contemptible
Superego: Deviant
Conscience: Distorted
Destructiveness: Interpersonal and Expressive crime
PSYCHOPATHIC: Malicious, Predatory
Superego: Perverse
Conscience: Inverted
Destructiveness: Strategic Conquest and Domination
SADISTIC:
Sadism
Superego: Defective and Perverse
Conscience: Inverted
Superego Development: Defective and Perverse
Destructiveness: Proloinged Anguish and Suffering
THE LEARNING THEORY OF SERIAL MURDER
As an alternative to the idea that serial killers are driven by "fantasy", at least one criminologist (Hale) has proposed that they are driven by humiliation or embarrassment. They perceive the world as full of "attacks" or "challenges" that cannot go unanswered. This acute need to reassert power is drawn from early childhood experiences where the offender felt powerless to control events. This need, combined with an arrested social development which includes problems at demonstrating mastery and at social comparison, results in the use of a victim as an audience to "set things right." In this view, serial killers are seeking approval from their victims.
Like all people, even the personality disordered are motivated to seek the approval of others. For various reasons, however, they experience feelings of frustration at finding ways to conceptualize how they would go about obtaining this approval from others. They actually anticipate failure without even trying. This is because they perceive the original person who humiliated them as superior or more "powerful" than they are. They then seek out vulnerable and less threatening persons as victims, who become scapegoats for the person who initially thwarted their needs for approval.
The diagnosis of "malignant narcissism" may be more apt for serial killers than "antisocial personality disorder" because it better exemplifies the connotation of evil that hangs over this domain of personality. A malignant narcissist is someone who exhibits antisocial personality traits combined with unrestrained aggression, a more pathological than deviant conscience, a strong need for power and recognition, distrust of others, and certain elements of sadism. Kernberg says that malignant narcissism develops as a defense against feeling of inferiority and rejection.
All criminals tend to have problems understanding social norms. They are more self pre-occupied than concerned with obeying the law. Serial killers, like many criminals, are driven more by the expression of their internal needs than a rejection of external forces. To maintain this schedule of "conditioning one's conscience", two things are necessary: alienation and isolation. Fromm said that alienation can be handled by ritualized behavior. Isolation simply limits exposure to societal sources of social control.
PRINTED RESOURCES:
Aronson, T. (1989) "Paranoia and Narcissism" Psychiatric Review 76(3):329-51.
Brown, N. (1998) The Destructive Narcissistic Pattern. Westport, Ct: Praeger.
Ferreira, C. (2000) "Serial Killers - Victims of Compulsion or Masters of Control?" Ch. 15 in D. Fishbein (Ed.) The Science, Treatment, and Prevention of Antisocial Behaviors. Kingston: Civic Res. Inst.
Fromm, E. (1973) The Anatomy of Human Destructiveness. NY: Holt, Rinehart & Winston.
Hale, R. (1993) "The Application of Learning Theory to Serial Murder: Or You Too Can Become a Serial Killer" American J. of Criminal Justice 17:37-45.
Hale, R. (1994) "The Role of Humiliation and Embarrassment in Serial Murder" Psychology: A Journal of Human Behavior 31:17-23. Horowitz, M. (1994) "Cyclical Patterns of States of Mind" Amer. J. Psychiatry 151(12):1767-70.
Kernberg, O. (1992) Severe Personality Disorders. New Haven: Yale U. Pres.
Kernberg, O. (1993) Aggression in Personality Disorders and Perversions. New Haven: Yale U. Press.
Kirmayer, L. (1983) "Paranoia and Pronoia" Social Problems 32(2):170-79.
Lowen, A. (1997) Narcissism: Denial of the True Self. NY: Touchstone Books.
Millon, T. & R. Davis (1995) Disorders of Personality: DSM-IV and Beyond. NY: Wiley & Sons.
Richards, H. (1998) "Evil Intent: Violence and Disorders of the Will" Pp. 69-94 in T. Millon et al. (Eds.) Psychopathy: Antisocial, Criminal, and Violent Behavior. NY: Guilford Press.
Ronningstam, E. (1998) Disorders of Narcissism. Washington DC: Amer. Psychiatric Press.
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