Mental health articles

Many of the diffi culties created by using extreme trait levels to defi ne disorder occur because trait constructs represent proclivities—tendencies to exhibit a given class of behaviors—whereas the concept of disorder refers more to competencies and disturbances of function. This suggests the need to defi ne disorder independently of trait extremity. There is also the problem that the concept of personality is not confi ned to individual differences in personality traits and the clinical concept of personality disorder refers to more maladaptive traits (Livesley & Jang, 2000). For these reasons, the DAPP system makes a clear distinction between the assessment of personality and the diagnosis of personality disorder. DAPP questionnaires are considered measures of personality disorder traits-ways to describe individual differences in personality— not measures of personality disorder.

Personality disorder is conceptualized separately as a disturbance in personality structure and functioning. Trait extremity is not a sufficient condition to determine the diagnosis although it increases the risk of disorder. It remains an unanswered empirical question of whether trait extremity is a necessary condition for diagnosis. When considering the nature of the dysfunction associated with personality disorder, it is useful to think of personality as a system of interrelated structures and processes (Costa & McCrae, 1995; Livesley, 2003: Mischel, 1999; Vernon, 1964) that includes: traits, personal concerns and motives, and coping strategies. It also includes the self-system and autobiographical sense of self that integrates past, present, and future experiences and events (McAdams, 1994). The psychopathology of personality disorder extends to all aspects of this system: it includes symptoms, situational problems, dysregulation of affects and impulses, maladaptive expressions of traits, interpersonal problems, and self-pathology (Livesley, 2003). Pathology also extends beyond the contents of the personality system to include its structure and functioning. For example, personality disorder invariably includes disturbances of self and identity that extends beyond maladaptive beliefs about the self and problems of self-esteem to more fundamental problems with the structure of self-experience as shown in a fragmented and unstable experience of the self or an impoverished self-concept.

The idea implies that personality disorder arises from extreme variation leading to disturbances in the normal functions of personality (Livesley & Jang, 2005). This proposal is consistent with Wakefi eld’s (1992) defi nition of the mental disorders as “harmful dysfunctions” that prevent internal  mental mechanisms from performing their naturally selected functions. To complete this defi nition, we need to explicate the normal functions of personality and specify the way these functions are disturbed in personality disorder. Allport originally noted that “personality is something and personality does something.” Trait theory is largely concerned with individual differences in what personality is. In contrast, social cognitive approaches are more concerned with what personality does. Some years ago, Cantor (1990) drew attention to Allport’s comment and in the process described the functions of personality in terms of the personal tasks that individuals face and set for themselves; the schemata used to construe these tasks, the self and life situations; and the strategies used to achieve personal tasks.

This analysis provides a conceptualization of personality functions that forms the foundation for a definition of personality disorder. The functions that Cantor described include specific dysfunctions such as problems with construal mechanisms and life tasks that are more pervasive in their effects. Although many of the specific dysfunctions have important implications for understanding and treating personality disorder, the concept of personality disorder implies something more pervasive. This suggests that personality disorder should be defi ned at the more abstract level of life tasks. Life tasks are the problems individuals face as a consequence of cultural expectations and underlying biology. The solution of these tasks is essential for satisfactory adjustment. Many life tasks vary with culture and stage of life such as the tasks faced by adolescents as compared to those of their middle-aged parents. However, some life tasks are shared by everyone because they are part of a common human nature.

These life tasks have evolutionary significance. They probably emerged from universal challenges that faced our remote ancestors in their struggle to survive and reproduce in the ancestral environment on the African savanna. This idea suggests that personality disorder occurs when “the structure of personality prevents the person from achieving adaptive solutions to universal life tasks” (Livesley, 1998, p. 141). This is a deficit definition which considers personality disorder to be a “harmful dysfunction” in the sense that it involves the failure to acquire the personality structures and functions required for successful adaptation.

We now need to specify universal life tasks. Plutchik (1980) described four universal challenges: The development of identity; the solution to the problems of dominance and submissiveness created by the hierarchy that is characteristic of primate social hierarchies; development of a sense of territoriality or belongingness; and solution to the problems of temporality, that is, problems of loss and separation. The life tasks posed by these universal challenges are remarkably similar to definitions of personality disorder from the clinical literature. Clinical psychiatry has traditionally considered personality disorder to involve either chronic interpersonal dysfunction or problems with self or identity, or both. Chronic interpersonal dysfunction is emphasized by Rutter (1987) who suggested that personality disorder is “characterized by a persistent, pervasive abnormality in social relationships and social functioning generally” (p. 454). Similarly, Vaillant and Perry (1980) noted that personality disorder “almost always occurs in an interpersonal context” (p. 1562). Self-pathology tends to be emphasized by psychoanalytic thinkers. This is illustrated by the importance of identity diffusion in Kernberg’s (1984) construct of borderline personality organization. Identify diffusion involves

. . . a poorly integrated concept of the self and of significant others . . . refl ected in the subjective experience of chronic emptiness, contradictory self-perceptions, contradictory behavior that cannot be integrated in an emotionally meaningful way, and shallow, flat, impoverished perceptions of others. (1984, p. 12)

In the same way, failure to develop a cohesive sense of self is central to Kohut’s (1971) account of narcissism. Cloninger’s (2000) suggestion that personality disorder involves low self-directedness and low cooperativeness combines both components. The apparent similarity of clinical concepts and ideas of universal personality functions makes it possible to express the failure to attain universal life tasks in traditional clinical language, while retaining an evolutionary perspective.

With this approach, personality disorder could be said to involve the failure to achieve one or more of the following: (a) stable and integrated representations of self and others; (b) the capacity for intimacy, to function adaptively as an attachment figure, and/or to establish affiliative relationships; and (c) adaptive functioning in the social group as indicated by the failure to develop the capacity for prosocial behavior and/or cooperative relationships. This definition is probably not specific to personality disorder. Most severe mental disorders are probably associated with these problems.

To differentiate personality disorder from other mental disorders, we need to introduce the caveat that one or more of these failures should be enduring and traceable to adolescence or at least early adulthood and due to extreme personality variation rather than another pervasive mental disorder, such as a cognitive or schizophrenic disorder. Several advantages accrue from defi ning personality as the failure to achieve adaptive solutions to universal life tasks. First, it separates the diagnosis of personality disorder from the assessment of individual differences in personality dimensions such as traits, thereby avoiding the problems created by defining disorder only in terms of extreme levels of a given characteristic. Second, it emphasizes the severity of personality disorder and clarifies the distinction between disordered personality and dysfunctions in relatively discrete aspects of personality such as an isolated trait.

Such dysfunctions may cause distress but they do not always lead to the extensive difficulties seen in patients considered to have personality disorder. Finally, the definition of disorder is based on an understanding of the functions of normal personality rather than on an arbitrary set of characteristics.

Tags: personality, personality failure