- 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 20^th 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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RELATIONSHIP HEALING:
MAKING RELATIONSHIPS WORK - SOME ASPECTS OF COUPLES / MARITAL THERAPY

The three essential life skills almost all of us weren’t taught at school:
- How to manage and make money
- How to be good enough parents
- How to be successful in relationships.

It’s estimated that couples / spouses who stay together for financial, religious, family, business, or other reasons when they really don’t get along without even a semblance of peace and joy in each other’s company, added to the divorce rate [over 54% in most western countries] would result in a finding that up to 80% or more of couples are in serious relationship trouble. Serious.

Unfortunately we tend to behave in ways that were modelled to us – by caregivers / parents / teachers / older siblings or extended family, and – alas! – horridly dysfunctional characters in most soap-operas and many books and movies. The problem with television-modelling is the immediacy and the repetitive nature of the characters’ interactions, and that it’s per se “allowed” in our homes. The unconscious mind is given the message that this is how people [may] behave in our home, work or other space. While a book may describe outrageous behaviour, we would interpret it idiosyncratically. (Think of how surprised you felt at times when a book was turned into a movie and the characters just look wrong compared to what you had in mind.)

In visual media, with colour, movement and sound added in screaming vividness, the modelling of behaviour, including facial expressions, micro-gestures, posture, tone of voice, etc., is exact. But we usually don’t get to feel the emotional and/or physical consequences of the behaviours thus modelled. No, we go for a sustenance break during the frequent adverts, and de-brief the impact.

But this does not happen in close real relationships. There we have to ride out the encounter not just for 11-16 minutes a day [all that’s left when advertising time, and subtitles or intro time is subtracted from the 30 minute program!], but we have to live “in the drama” 24/7, day after day, week after week, for months, for years.

It holds for all close relationships, not just romantic ones. Relationships with colleagues, managers or underlings may need to be managed – or survived – for 40 hours or more a week. Relationships with school-going kids draw us in for about 10 hours a day and may drive a parent to distraction during weekends and vacations! Yes, we drive the kids nuts too…

Fact is that our level of esteem for our Self, our trust in our self to care for our self, our regard and respect for our self as a worthwhile and respect-worthy entity, our enjoyment and discipline of self, etc, determines how we behave in relationships. Again, these factors are generally created by negative and positive experience of self-in-relation-to-significant-others when we are very young.

Donald W Winnicott [UK analyst, C20] talks about being a Good-Enough or Not-Good-Enough parent. A good-enough parent basically has relatively few failures in understanding, accepting, respecting and responding appropriately to the child’s needs (physical, social, mental and emotional). This parent’s few failures can be forgive [and usually forgotten] in the matrix of appropriately empathic interactions that provide a properly nurturing environment for the child.

Now let’s look at those qualities again:
- being empathic*, i.e., understanding the world from the child’s point of view, and responding appropriately to his/her emotions and needs
[*by the way, there’s no such word as “empathetic”, which is a bastardisation/erroneous amalgam of empathy & pathetic, two words with completely different meanings!]
- respecting, i.e., granting the child the right and power to impress his/her interpretation of events on the world [e.g. the parent] and have his/her needs and feelings validated
- valuing the child as precious / estimating the child’s value to be high, so that his/her needs and communications are judged high priority
- being consistently trustworthy in care for the child
- giving the child the constant message that s/he is worth respect, trust, adoration, affection and healthy discipline; that s/he is adore-able
- I’d like to add too the list Carl Rogers’ [1940s] idea of unconditional positive regard.

There are many excellent books that teach us how to have really great, functional, and healthy relationships. Some of my favourites are:
- Dr Phillip McGraw: Family First – a blueprint for healthy close relationships in context of family
- Dr Phillip McGraw: Relationship Rescue – for those who’ve already inflicted much injury
- Tony Humphreys: Myself, My Partner – an excellent book, sadly out of print but very worth buying “used”. It works from the basis of relationship with Self to that with Other
- David Richo: How to be an Adult in Relationships – The Five Keys to Mindful Loving – This great book, published in 2002, suggests a holistic, mindful approach, which really helps to improve various kinds of relationships swiftly and with great success
- Thomas Harris: I’m OK, you’re OK – based on Transactional Analysis as proposed in Eric Berne’s The Games People Play, this book is an easy to read, understand and apply in any relationships.

David Richo’s book has an easy 5 concept recipe for success that I have found useful in all relationship counselling or therapy, between adults in various roles, including marriage or intimate relationships, or friendship, or work relationships, as well as between children, and between child & adult,and groups in interaction. [It even seems to work in relationships with dogs – manipulators, cats – controllers, and pot plants – demanders!]

Richo pre-supposes that healthy relationships is our right and obligation – or even “calling”, and gives us the tools that are guaranteed to help us have wonderfully healthy relationships with Ourselves and Others. Here are his “Five A’s”:
- Attention: I am paying close, respectful attention to Me /You
[not ignoring, being unavailable, interrupting, etc]
- Acceptance: I accept me as I am / you as you are, in this moment
[not trying to make someone over to our specifications]
- Allowing: I allow me to be myself / you to be yourself, to be free to grow to the best Self possible
[not being controlling, demanding or manipulative]
- Appreciation: I appreciate myself / you for what I / you have been, and are
[not criticising]
- Affection: I have real affection for myself / you, no matter what
[not acting selfishly or abusively]

No matter what the “diagnosis” of the relational problem/s, behaving from such a mutual mindful and respectful approach, will result in healing. Note that it needs to be mutual to last, but it can start from one side only, eliciting similarly better behaviours from the other side over time: “You teach people how top treat you” – as Dr Phil often says. Also remember that you need to start behaving towards yourself in this mindful manner: not only will others tend to respond to you similarly to the measure they observe you respect yourself, but in doing so you will become your own ally – the “inner child” will no longer have to behave so defensively when there is stress, empathic failure, or disagreement.

But a quick diagnostic tool is useful. Observe how successfully the relationship is working on three tiers represented in this pyramid: 

 The base of the relationship pyramid is Communication. If this is not mutually healthy, clear, respectful and appropriately responsive, the relationship cannot be great [even if the sex is and both parties are equally wealthy!]. You can’t fix Intimacy if Communication is dysfunctional. The next tier is power. Is the financial, social, decision-making, [etc] power shared equally or fairly, according to the needs of both? If not, some aggressiveness / passive-aggression or withdrawal / sabotage is highly likely to subvert both Communication and Intimacy. Finally, if both lower tiers are good, but Intimacy [emotional, physical, spiritual, sexual etc] is not satisfactory, this may cause reflexive problems in Communication and how Power is used. I suggest you try applying the ”Five A’s” and other quality behaviours at all three levels, from the bottom up.

Finally, although self-help questionnaires, books and workbooks can be wonderfully effective, most people will probably need a trustworthy coach-mentor-referee-witness to accompany them on the healing journey, in order to maintain openness and balance different points of view, as well as reintroduce realty when necessary.

I would go to a specialist, not just any doctor at random, if something in my body was seriously impaired. Similarly, I suggest that couples and other people with relational problems, consult a therapist or counsellor [or lay counsellor etc] who is properly trained and knowledgeable, but also thoroughly experienced in the field of relationship therapy. Ask about experience and competency: it is your right, and your responsibility to yourselves and your relational well-being.