Psychodynamic Flavors of Personality

If you remember from the Psychodynamic Personality Classifications (as Ice Cream) blog, there is a categorical “axis” that helps us understand the flavors of personality within the psychodynamic lens. I call this “The Character Axis: Flavor Category of Ice Cream,” which we can visualize like this:

While these categories are heavily expanded upon in Nancy McWilliam’s book, Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, the Psychodynamic Diagnostic Manual, Second Edition (PDM-2) contains even more categories and includes subtypes of personality. Also note that the PDM-2 has more personality types than we highlighted in our podcast.

Paranoid Personalities

Subtypes: None.

DSM-5-TR	Included, but differs in focusing on the external processes, while the PDM-2 focuses on the internal processes.
Millon	Included and similar.

Paranoid personalities have a fairly stable history that has not changed much. They find their emotions, desires, and thoughts unacceptable, so they reject them and put them onto others (projection). An example of projection might be reacting to others’ behavior, when really they are the one acting that way. They often feel fear, rage, shame, contempt, hatred, hostility, disgust, and envy, which are all deemed unacceptable and are thus seen as coming from outside themselves. They can also project dependency and attraction (i.e. paranoid jealousy) and believe they are in constant danger because the world is full of others who are potential threats. They expect to be attacked and humiliated by others so they aggressively humiliate and attack first in order to lessen their anticipatory anxiety. They are suspicious and distrustful of others, overly hypervigilant in waiting for the attack and on constant alert of possible exploitation.

Schizoid Personalities

Subtypes: None.

DSM-5-TR	Included, but differs in focusing on the external processes, while the PDM-2 focuses on the internal processes.
Millon	Included, but a mix of the PDM-2 and DSM-5-TR understandings.

This is one of the more confusing pieces of psychology because the prefix schiz- (schizoaffective disorder, schizoid phenomena, schizoidism, schizophrenia, etc) and the term “schizoid” have been used in so many different ways. Importantly, schizotypal personality disorder in the DSM is absent in the PDM-2 because the PDM-2 believes it is a trait common in schizoid types, not its own personality. Here, we are discussing the PDM-2’s understanding of schizoid personalities, which aligns well with schizoid phenomena but differs significantly from the DSM. The DSM focuses on the outward expression of schizoid persons: little emotional expression, indifference, lack of closeness to others, lack of pleasure, lack of interest in sex with others, preference for solitary activity, and lack of desire/enjoyment of close relationships (a deficit-based description). In contrast, the PDM-2 maintains that internally, there is actually a fear of closeness that conflicts with a yearning for closeness because they believe love and dependency are dangerous, and the social environment is intrusive and engulfing (conflict-based description). The PDM-2 also notes that both the deficit- and conflict-based view of schizoid likely exist on a “health-illness” continuum, with the conflict-based version found in higher-functioning ranges.

Schizoid personalities are extremely sensitive, easily overstimulated, and shy. Overstimulation on the outside results in overall emotional pain, and they feel their emotions so intensely and powerfully that they have to detach from them. They can do this by withdrawing physically to be alone and without others, as they are more comfortable that way. However, when this happens, they desire closeness and fantasize about intimacy. They can also withdraw into their minds, thoughts, and fantasies, detaching from their own needs and the outside world.

Psychopathic (Antisocial) Personalities

Subtypes: Passive-Parasitic, Aggressive.

DSM-5-TR	Included as Antisocial Personality Disorder.
Millon	Included as Antisocial Personality.

The PDM-2 prefers to use the older term “psychopathic” instead of antisocial to describe this type of personality, which makes sense because, as stated in the PDM-2, these individuals are not necessarily against social norms (antisocial), nor are they incapable of social interaction (asocial). They can actually present as charming and charismatic with a capacity to read others’ emotions accurately, but their own emotions are poor and depleted, with the exception of rage and envy, which are more easily experienced. Though they actually have a high desire for stimulation, they seek power because they want it, finding pleasure in deceiving others in their journey toward more control. Fearing control and manipulation, they believe others are inherently selfish, weak, and dishonorable. Thus, psychopathic characters act in controlling and conniving ways, believing they can do whatever they want, without regard for morality.

They are extremely aware of their environment, but think and behave from a selfish perspective, always putting themselves first. They lack emotional connection to others, and what relationships they do have tend to focus on how useful the other person is. Their indifference to others includes a lack of remorse and empathy when they harm others, though they do not find pleasure in harming others like a sadistic personality type would.

There are two subtypes of psychopathic personalities. The passive-parasitic personality can be understood as a con artist, imposter, or scammer, passively but manipulatively “one-upping” others to gain control and power. The aggressive subtype is overtly more combative, actively harming and stepping on others to gain their control and power, perhaps more often tapping into their rage.

Sadistic Personalities

Subtypes: None.

DSM-5-TR	Not included.
Millon	Included.

Sadistic personality disorder was considered in the DSM-III-TR but thrown out in the DSM-IV, perhaps because of the belief that there is overlap between sadistic personalities and antisocial personalities. However, you can have a sadistic personality without antisocial personality, and vice versa. Though some can fall into both categories. Another hypothesis is that sadistic personalities are not often seen in clinical settings, usually only forensic settings. On an interesting note: those who fantasize about and/or enact sexual sadism are not all sadistic personalities, but it is likely that all sadistic personalities have a preference for sexual sadism.

Sadistic characters desire and feel entitled to humiliate and hurt others, often feeling contempt and “cold” hatred (hatred that lacks anger). They find pleasure and sadistic glee in inflicting suffering on others, but they do so in a calm and detached manner without feelings of guilt, remorse, or empathy. They tend to dominate others due to a need for control, and elicit a predator-prey dynamic. For example, when interacting with a sadistic personality type, you might feel creeped out, intimidated, and uneasy, with a desire to flee or hide - a very adaptive response to the threat that sadistic personality types portray.

Borderline Personalities

Subtypes: None.

DSM-5-TR	Included.
Millon	Included.

Again, borderline personalities have such an interesting history. The PDM-1 did not include a categorical understanding of borderline personality, only a borderline level of personality organization. However, the PDM-2 notes it has now included the borderline personality category because of the pervasiveness of the concept, especially since the DSM-III added borderline personality disorder in 1980.

Borderline personalities have difficulty handling and regulating their emotions because their emotions tend to be intense, extreme, and out of control (especially fear, shame, and rage), which impairs their functioning. Because they can’t self-soothe, they depend on others to comfort and regulate them. However, being too close to someone is also scary. They need a safe person they can be close with, but they fear being too close to them because they fear rejection and abandonment. This results in treating others in a confusing push-pull way (similar to disorganized attachment styles) of “desperate clinging, hostile attack, and dissociative-like states of detachment” (PDM-2 p. 53). Thus, they have difficulty keeping stable relationships.

Often having developmentally regressed self-centeredness, they have difficulty putting themselves in others’ shoes, believing that others are thinking/feeling what they are thinking/feeling (projection). Thus, they tend to split into believing someone is all good or all bad, which can flip flop easily. They can also flip between different parts of themselves, as their sense of self tends to be fragmented instead of cohesive. Embodying self-identity concerns, they may not know who they are and instead, usually feel an emptiness, “empty spot,” or inner void within themselves that they try unsuccessfully to fill.

Hysteric (Histrionic) Personalities

Subtypes: Inhibited, Demonstrative.

DSM-5-TR	Included but describes the demonstrative subtype. “The DSM diagnosis of borderline personality disorder essentially depicts hysteric-histrionic personality organized at a borderline level of severity (cf. Zetzel, 1968)” (PDM-2 p. 44).
Millon	Included.

Histrionic personalities have a long history, stemming from descriptions of hysteria and hysterical psychosis, and it used to be called “Emotionally Unstable” in the DSM-I (1952). Though having an unfortunate namesake and a rather dark history, histrionic personalities today can be found in any gender/sexuality/orientation (or lack thereof). They are overly focused on gender, sexuality, and power, and they fear internal overstimulation of their own emotions and desires. They often have emotional experiences of guilt, shame, and fear, but they seemingly attempt to push it to the surface, speaking in dramatic ways and being impressionistic. They can also experience conversion symptoms if their emotions or desires become too much.

At an unconscious level, hysteric character types devalue their own gender, believing there is something problematic, weak, inferior, and/or defective about it. However, they envy the opposite gender, finding it to be exciting and powerful, but also frightening, highlighting a conflict among genders and their meanings. They often address this conflict by flaunting sexuality in an exhibitionistic manner, being seductive to gain power and defend against the perceived weakness of their own gender, while pursuing conquest over the opposite gender. While histrionic was born out of a binary gender culture, it still applies in the present day where gender and sexual fluidity is more socially acceptable. The difference is that the histrionic person may be reacting against the opposite side of the gender or sexual identity continuum vs the binary male/female category.

The demonstrative subtype tends to occur more in cultures that do not try to control gender and sexuality (i.e. Western societies), and they present as more seductive, attention-seeking, dramatic, and flamboyant. Whereas in cultures that attempt to control gender and sexuality, the inhibited subtype is more likely, presenting as naive, conventional, and sexually avoidant/unresponsive. Regardless of subtype, actual sexual intimacy is anxiety provoking and conflictual due to fear of being hurt by the powerful gender (opposite gender) and shame of their own gender. Sexual behavior tends to be completely separated from internal experiences.

Narcissistic Personalities

Subtypes: Overt, Covert, Malignant.

DSM-5-TR	Included, but describes the overt subtype.
Millon	Included.

Narcissistic personalities suffer from wounded self-esteem, an unstable sense of self, as well as an internal sense of emptiness, though they often conceal these weaknesses through a grandiose presentation. These characters also defend against their wounded self-esteem through both idealizing someone, which makes them feel special by association, or devaluing someone, which makes them feel superior. They tend to experience both anxious and avoidant attachment styles, behaving in ways that are toxic and destructive to others and lacking internalized morality. Thus, their emotional experiences often contain humiliation, shame, envy, and contempt. They spend lots of energy analyzing their own status in comparison to others. They need affirmation of their own value and importance, but cannot find it internally, so they require it externally and believe that the more they have, the better they will feel.

There has been significant research that parses out subtypes of narcissism. The DSM-5-TR describes the overt narcissism that the PDM-2 outlines. The overt narcissism usually occurs when the environment meets needs of wealth, success, admiration, and status, resulting in grandiosity, arrogance, elation, a sense of entitlement, and contempt toward others. Malignant narcissism is a type of narcissism that is blended with sadistic aggression, which is the most problematic type of narcissism. Covert narcissism tends to occur when the environment does not meet needs of wealth, success, admiration, and status, resulting in fantasizing about it, but feeling envy, shame, and depression. These individuals tend to be ashamed, shy, and avoid relationships.

Anxious-Avoidant and Phobic Personalities

Subtypes: Counterphobic (converse manifestation).

DSM-5-TR	Similar to Avoidant Personality Disorder but is also captured in non-personality diagnoses such as phobias and generalized anxiety disorder.
Millon	Similar to Avoidant Personality but also captured in generalized anxiety.

The first edition of the PDM split this type of personality into two categories: Anxious and Phobic (Avoidant), but the PDM-2 hypothesizes they are all in a similar cluster containing characterological anxiety. Though controversial, the PDM-2 notes that there is a personality component to anxiety for some people, where (similar to depressive personalities) anxiety is intertwined into who they are. The DSM-5-TR captures this as symptomatology through phobic disorders and generalized anxiety disorders; however, avoidant personality disorder is included in the DSM. Similarly, Millon assesses both avoidant personality and generalized anxiety symptoms.

Anxious-Avoidant and Phobic personalities are centered on their emotions of fear, experiencing a conflict between safety and danger. They believe they are always in danger, and they have to avoid it somehow. Phobic and avoidant personalities attach their anxiety onto a certain situation or object, which they go to significant lengths to avoid. Anxious personalities have an overall universal anxiety that they can’t pinpoint. They are reserved and shy, usually have anxious attachment styles, and feel scared when they are alone, which can often result in others feeling protective of them. They also tend to feel inferior, inadequate, inhibited, and indecisive, and they have difficulty describing and recognizing their own emotions.

The counterphobic subtype is opposite of this, as instead of being swept away by their fear, they go against it. They seek out danger and risk by rejecting then projecting their anxiety. It is uncommon to see this counterphobic presentation in clinical settings because they are not apt to ask for help. Instead, they likely put on their bravado and rush toward the threat.

Dependent Personalities

Subtypes: Passive-aggressive, Counterdependent (converse manifestation).

DSM-5-TR	Included.
Millon	Included, but parses out Masochistic/Self-Defeating types.

Dependent personalities are organized around excessive dependency needs. They feel needy, helpless, passive, worthless, and inadequate, so they define themselves in terms of others and seek comfort and security in relationships. Their main focus is on keeping their relationships and avoiding criticism and abandonment. Thus, they have a difficult time expressing anger. They feel afraid and sad when by themselves, but find pleasure in a close relationship. Sometimes to maintain the attachment and care of others, they present as younger/childlike and naive. Dependent characters view others as powerful and believe they need (but can resent) others’ nurturance. At a severe level, they stay in unhelpful relationships even when exploited/abused (self-defeating or masochistic version of dependent personalities).

The passive-aggressive subtype also feels inadequate and dependent, defining themselves through others. However, they view the other with hostility and negativity. This subtype finds their own direct anger or aggression to threaten the relationships they need, so it spills out in passive-aggressive behavior and indirect attacks on others.

The counterdependent subtype goes against their impulses. They reject their strong dependency needs, including any emotional vulnerability. However, there is usually an area where dependency needs are secretly expressed. They are unlikely to be seen in clinical settings because they reject asking for help.

Obsessive-Compulsive Personalities

Subtypes: Obsessive, Compulsive.

DSM-5-TR	Included but focuses on the external presentation instead of the internal presentation.
Millon	Included.

Obsessive-compulsive personalities prefer to function as if emotions are unnecessary, believing a lot of emotions are dangerous and need to be controlled (righteous anger is acceptable). They are very resistant to feeling out of control because they believe their own urges will result in destruction, mess, greed, or aggression. Their guilt is intense, resulting in a rigid, punitive, and harshly self-critical inner voice. They defend against feelings of guilt, shame, fear, anxiety, and anger by “undoing” or counteracting them through being overly rational, logical, detail-oriented, rigid, orderly, and organized. They are overly concerned with rules, procedures, and productivity, which impairs their relationships and ability to relax. These character types hold themselves and others to very high standards. They experience conflict between giving in to others’ demands, which results in shame and rage, or rebelling/defying others, which results in anxiety and fear of retaliation. The obsessive subtype is cerebral and constantly in their head thinking, judging, doubting, reasoning, and ruminating because their self-esteem stems from thinking. The compulsive subtype is meticulous, perfectionistic, and busy, constantly “doing and undoing” by collecting, perfecting, and cleaning because their self-esteem stems from action.

Somatizing Personalities

Subtypes: None.

DSM-5-TR	Not included in personality conceptualization. Somatizing can be found as a symptomological disorder under Somatic Symptom and Related Disorders.
Millon	Not included in personality conceptualization.

The DSM has always considered somatic disorders as separate from personality, and Millon’s theory seems to share this belief. These individuals are more likely to be seen in medical settings in comparison to psychological settings. However, the PDM-2 notes that it is very difficult to parse out the personality piece from other somatizing and medical factors, but maintains that there is a personality influence toward those whose psychological pain is mainly expressed through bodily symptoms and concerns about the body. In fact, they often experience alexithymia or an inability to verbally express emotions, though they may experience overall distress and eventual rage. They view themselves as helpless, unentitled, unheard, powerless, and vulnerable, with a fragile sense of self and a fear of dying. In contrast, they view others as healthy and powerful, as well as indifferent. In some cases, they may have learned that in order to maintain care and attachment with a loved one, they have to be and remain sick.

Depressive Personalities

Subtypes: Anaclitic, Introjective, Hypomanic (converse manifestation).

DSM-5-TR	Not included in personality conceptualization. Depressive symptomatology can be diagnosed as persistent depressive disorder.
Millon	Introjective depressive listed as Melancholic; Hypomanic listed as Turbulent

Depressive personalities are controversial in the field of psychology. While the PDM-2 and Millon (Melancholic) noted that there is a personality type whose tendency toward and experience of depression is intertwined into who they are, the DSM-5-TR has parsed that out as chronic depressive symptoms.

They have difficulty experiencing positive emotions (sometimes even rejecting them), but no difficulty at all feeling all the negative and painful ones like guilt, shame, sadness, and inadequacy. The introjective subtype correlates to Millon’s melancholic personality type. They tend to turn their (unconscious) anger inward, being self-critical and self-punitive, believing there is something fundamentally bad about them. They blame themselves for things because it’s too threatening to blame others.

The anaclitic subtype tends to be preoccupied with rejection and loss, believing that if someone actually gets to know them, they’ll be rejected. They fear abandonment and rejection, but also feel alone when they are with others. This subtype desires relationship, intimacy, and warmth, but instead feels lonely, incomplete, and empty. Existential depression and nihilism are common in this subtype. Regardless of subtype, depressive personalities are often found in clinical settings.

The hypomanic subtype uses positive energy, high self-esteem, mild mood inflation, and optimism to intensely fight against and avoid their sadness, appearing opposite of those with purer depressive features. They often don’t tolerate psychological treatment and can run from relationships to avoid being abandoned.

Note on Masochism

The term masochism has been utilized in many ways within psychology, but all include an (unconscious) investment in suffering. While the DSM previously considered masochistic personality disorder, it was rejected in the DSM-IV-TR; however, Millon still includes it in his theory. The PDM originally included masochism as its own personality type. However, the PDM-2 ended up describing the concept of masochism, but did not propose it as a standalone category because masochism can be found in various other personality types (i.e. dependent, narcissistic, sadistic, paranoid).

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References

• Lingiardi, V., & McWilliams, N. (Eds.). (2017). Psychodynamic diagnostic manual: PDM-2 (2nd ed.). The Guilford Press.
• McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.