DIFFICULT PEOPLE: From basic personality Traits to destructive Personality Disorders

         – Please also see article on “Toxic People” on this web site

Unfortunately it is true that every one of us – even the most saintly – has some character traits that irritate some other people!  The good news is that it’s not always the fault of the person who is perceived to be irritating:  for instance, a “Type A Personality” may benefit from having some traits of more peaceful and joyful people that s/he finds highly annoying because they may not behave rashly enough to suit his/her needs for immediate gratification.  So, the person described as “difficult” may not be as problematic interpersonally as the one who describes him/her in such terms.Traits are considered to be dysfunctional if they interfere significantly with our optimal functioning in our personal life [e.g. causing depression, anxiety, addictions], our social life [e.g. our ability to function effectively socially or in intimate or family relationships], or our work life [e.g. in concentration, or in relationships at work].


Character or personality traits are qualities we all have, in various combinations.  They can be adaptive or functional, like certain life skills:  An accountant needs to be precise in her work, but hopefully not in exact in the way she arranges her flowers every day.  That would be bordering on maladaptive or dysfunctional behaviour, and may be traits or indicative of a fixed and invasive Personality Disorder which generally can affect people around her negatively or lead to arguments or rejection.


Traits are called ego-syntonic if we are proud of them and wish to keep them, despite others not believing we should indulge in them, or despite their interference with our optimal functioning as described above [e.g. “I like being aggressive: it gets me what I want”].  Traits that we ourselves recognise as dysfunctional or negative are termed ego-dystonic [e.g. “I would like to stop being addicted to cocaine because I realise it’s harming me and my family”].


Certain clusters of traits appear to occur in set patterns and are always dysfunctional. These clusters are diagnosed only in adults [i.e. people over 20] and are well researched so that reasonably accurate conclusions can be drawn as to their causes and how they affect an individual and his/her life.  We can even predict with reasonable validity when a teenager who displays these clusters is likely to develop them into the fixed patterns of behaviour called Personality Disorders, by the time s/he reaches adulthood.


Although a person must fulfil all the criteria to be diagnosed with a Personality Disorder [and only a professional with clinical certification, like a psychiatrist or a clinical psychologist, may make such diagnoses!], some adults have enough of the traits to make their or others’ lives a misery – hence “difficult people”.


The following PDs [Personality Disorders] are stipulated in the current Diagnostic and Statistical Manual of the Psychiatric Disorders [DSM].  There are also other proposed categories [e.g. Depressive PD] that are being researched and may be added later.


CLUSTER A                                     CLUSTER B                         CLUSTER C

PARANOID PD                                ANTISOCIAL PD                 AVOIDANT PD

SCHIZOID PD                                  BORDERLINE PD                DEPENDENT PD

SCHIZOTYPAL PD                          HISTRIONIC PD                  OBSESSIVE-COMPULSIVE PD

                                                       NARCISSISTIC PD              PD NOS [Not Otherwise Specified]


Personality traits are not chosen as an act of will, and they are not signs of “madness”, though they may make people feel “mad, bad, or sad” if the traits are strong! [with prevalence of the traits notated as ++ or +++].  “Madness” [or psychosis] implies that an individual is frequently and grossly out of touch with reality, and no longer generally able to function effectively in his/her life – personally, socially or occupationally.  Even persons with “text book” PDs, tend to function quite well in some of these areas most of the time, and – except for Antisocial PDs – are usually not hospitalised or institutionalised [eg in forensic settings] – unless there is a specific symptom or threat such as attempted suicide.


Even for certifiable “madness” [psychosis – see below], there is always a Cause or Etiology.  The old psychotherapy cliché “It’s all my mother’s fault” is not as inappropriate as most of us would prefer it to be, especially if we are a parent or a caregiver! But the failure to make an individual feel safe and wanted in the world is often caused by peers, or by other authority figures or caregivers than the mother.  


Defense / Coping mechanisms are the infant’s and the young child’s attempt to ward off perceived terror / anxiety in repeated early situations that suggest to the person that s/he is in danger of abandonment / rejection / annihilation that would end in the destruction of the integrity of the Self.  Such defense mechanisms are not “genetic”, although symptoms could be similar: Being born with brain damage, for instance, may predispose a person to act out violently, similar to someone with Antisocial PD, or to have severe mood swings like someone with Borderline PD;  however, the cluster of symptoms and etiology is what allows us to differentiate between various mental disorders, according to a Differential Diagnosis.


Other disorders now clearly associated with brain damage [eg low brain matter density and resultant enlarged ventricles] include psychotic disorders, like the schizophrenias [typically demonstrating symptoms like auditory hallucinations or various delusions], and these may be aggravated by inadequate parenting. 


“Psychotic / psychosis” implies an inability to stay primarily in objective reality.  We might all like to call our mother-in-law or boss a “Devil”, but when we actually believe her/him to be Beelzebub, horns and tail and pit of sulphur and all, we are diagnosed as “psychotic”.  Psychosis may usually be indicated in any of three categories: 

[1] Not being orientated to Person [who I am], Place [where I am], Time [when is this] or Situation [what is happening]. 

[2] Hallucinations [seeing or hearing or smelling or tasting or feeling things that are not there as if they are, or vice versa, not experiencing them when they are present], or Illusions [experiencing distortions in sensory perceptions, such as “walls bending in on me”]. 

[3] Delusions [fixed beliefs that are not real to objective others, eg “I can fly off the roof”, or “There is a snake in my belly and it’s eating me up inside”].  Note that such psychotic symptoms are commonly associated with people who do not have a general psychotic illness but who are intoxicated by drugs, and they can also occur in certain cultural milieu such as “mass hysteria” and a “calling to be a spiritual healer”, without indicating a fixed psychotic disorder.


NB: Note that psychiatric disorders are diagnosed according to an Exclusion principle, i.e. first eliminate possible medical causes of symptoms, then possible substance causes, then genetic, etc…   And diagnoses are based on patterns or clusters of symptoms, not on a single symptom.  [This means, Gents, that a woman who is pregnant and has mood swings because her hormones are not balanced, may NOT primarily be diagnosed as “Borderline” because of the one symptom;  it is however possible to be both Borderline PD and pregnant.]


While people with PDs may have certain symptoms that appear delusional [such as the belief “I am the greatest person on earth and therefore deserve special treatment” in Narcissism, or “I am helpless and can’t do anything for myself” in Dependent PD] or hallucinatory [such as the body dysmorphia associated with some eating disorders], the person with a PD moves generally in the world of objective reality, with short lapses into unreality [often described as micropsychotic episodes] from which s/he can usually emerge without medication or any overt intervention.


PDs are resistant to therapy:  How can one be expected easily to give up the very habit/s one unconsciously believes are the only defense that wards off one’s annihilation?  For the first part of the 20th century Freud and his followers generally de-selected people for analysis if they suffered serious deficits such as found in the PDs.  Even in face-to-face psychoanalytic therapy it could take many years of thrice or twice a week therapy for the PD to abate sufficiently for people to live more peacefully with others and themselves.  Speedier results have been reported with modern integrated therapies that include techniques like Hypnosis or EMDR, but the danger of causing collapse if the defenses are too quickly overwhelmed, is significant, and such work should only be attempted by licensed and experienced or supervised clinical psychotherapists.


Remember that PDs are formed after repeated and continuous failures of caregivers to provide a safe, accepting, welcoming, non-intrusive yet stimulating, caring environment, with appropriate freedom and boundaries, over time.  And none of us are taught this art in schools!  We learn our parenting skills from the often inadequate role-modelling by our own parents, early teachers and other caregivers.  And if there is a severe enough failure to provide such a safe and nurturing environment by even one “big person” [such as being emotionally abused by a teacher or sexually molested by a family member], not even the best efforts of relatively good parents may be sufficient to ward off severe defensive traits or even disorders of the personality.


Half a century ago British psychoanalyst Donald W Winnicott coined the phrase “good-enough mother”, which can be extrapolated to good-enough parents, father, nanny, teacher, etc.  Different behaviours are required of good-enough parents in the child’s different developmental stages [for instance, not still breastfeeding the seventeen year old may be a good idea].  An infant psychologically needs a great deal more eye contact and physical holding than a teenager, as another instance.  Modern psychotherapists generally believe that optimal provision of a child’s emotional needs should include unconditional love / positive regard, freedom from intrusion and neglect, and appropriate boundary setting for his/her behaviour, and some add optimal frustration, which stretches his/her resourcefulness without being overwhelming.


When parents / significant others repeatedly fail in one or more of these areas, the child is likely to develop such strong defenses against unconscious fears of being hurt / annihilated / abandoned / rejected, that the formation of a PD defensive structure is likely.


So, generally “difficult” people can become “nicer” people if they get a chance to have these basic developmental needs consistently met at some stage in their life, for instance in therapy.  In interaction it nay be useful to remember that the “difficult” behaviour in any specific moment points to a fear of a perceived threat:  If Alex suddenly becomes bombastic / grandiose/ arrogant, it’s likely that someone has done something [or Alex believes in fantasy  that this has been done!] to make her/him feel small, powerless, disrespected, ignored, diminished, worthless, unheard… [for instance, in ignoring his/her contribution to a discussion].


The answer to the question of how to change his/her defensive behaviour seems obvious:  to acknowledge that s/he is worth some positive regard.  Similarly, if Ashley is acting in an over-controlling manner, it is likely that more structure or safeguards are necessary in the situation/s that evoke the behaviour.  But such “therapeutic” responses are hard to sustain in practice with a “difficult” person, who may often have the effect on others to suggest or make them feel “mad, bad, or sad”!


Some specific examples of various PD’s are discussed in the 2009 monthly Selfgrow newsletter, to which you can subscribe on this web site.  There are also various internet News groups that focus on specific Personality Disorders.


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