Early Episodes | Personality Couch

Ep 18: The 6 Mental Health Trends: A Review of 2024

Tue, 31 Dec 2024 02:00:01 +0000

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) explore the cultural and clinical trends of 2024, focusing on global unrest, political polarization, re-examining power dynamics, and the ongoing mental health crisis. We discuss the impact of trauma awareness and the complexities of the victim mentality, as well as state-specific mental health trends revealed through recent research. In this episode, we further explore the state of mental health in America, discussing various mental health trends across states, the impact of misinformation on mental health, and the public’s outrage towards healthcare practices, as evidenced in the assassination of United Healthcare’s CEO. We delve into the role of venture capital in telehealth and the ethical implications of profit-driven healthcare. The conversation emphasizes the need for advocacy and ethical change in the mental health landscape, urging listeners to engage in positive dialogue and action.

Personality Couch Episodes Referenced:

Additional Podcast References

Global Election Results

Trauma and Our Perceptions

Mental Health Trends By State

Mental Health Venture Capital Companies’ Impact

2024 Trends (6 Cultural Shifts Impacting Mental Health)

Tue, 31 Dec 2024 02:00:00 +0000

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Global Fed-Up-Ness

I think it’s fair to say that we’re all pretty disgruntled and discontent with …well everything - jobs, prices, authorities, the state of affairs, life in general, etc. It probably started before the pandemic, but during and since the pandemic, it has absolutely skyrocketed. And this is the foundation of the world and our nation (U.S.). We actually have some overt data that highlights the desire for change, like the person who held the position/power in every single major developed country with an election in 2024 LOST¹. All of them. Every single one. No matter what they stood for. At the very least, this shows us that change is desired. But a change in what? Well, apparently any change. We’re just not happy, and we most definitely know it. We’re fed-up.

Photo by Siavash Ghanbari on Unsplash

Polarization

Because of the unrest in the world, we are polarizing and splitting, which I think reflects the fear and hatred felt. We’re unfortunately attributing the goodness/badness of a person to what they believe instead of who they are. People are against people. But do you happen to remember a time when people were against the problem instead? I believe we’re feeling like we’re in danger, but the threat isn’t able to be seen, held, or maybe even defined. We’re running around with hypervigilance of ‘who is out to get me today?’ There’s no ONE person or group or power…but that means we can’t protect ourselves from something concrete. To handle this, we blame it on a group (i.e. political party, race, gender, generation) to feed the illusion of having control and power. It’s not helpful. It’s just playing into the danger and dividing the people. It’s heartbreaking.

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Re-Examing Power Dynamics and Trauma

Polarization is leading to re-examination of power dynamics, including inequality and injustice, between groups. At the same time, or maybe even because of this, we’re discovering the underbelly of powerful groups and people - which isn’t pretty. This year, we’ve seen the Hollywood P Diddy² scandal. How can we even wrap our heads around the evil happening? We split and project. But we also seem to lean into helplessness and powerlessness - the victim mentality. See, we used to deny trauma and sweep it under the rug. Now, we’ve swung toward the opposite extreme, as we’re expanding our definition of trauma into anything that causes distress. It’s actually not helpful to do this because we start getting stuck and avoiding healing. Check out a study by Kleck and Strenta (1980)³ highlighting how we expect to be treated negatively if we’re different. And in 2022, Jones and McNally⁴ did a study that outlines the broader our beliefs of what trauma encompasses, the more vulnerable we might be to the negative effects of trauma.

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Mental Health Crisis

We also have to understand that all this correlates with (or maybe even caused) the mental health crisis we’re facing (U.S.). Mental Health America⁵ reported that in the past year, 23.08% of adults experienced mental illness with 5.86% having severe mental illness and 5.04% having serious thoughts of suicide. We’re not okay, and the numbers are showing us that. But what do we do? The Manhattan Mental Health Counseling⁶ looked at Google trend searches for mental health disorders by state. Why does this matter? Because we’re turning to “Dr. Google” and “Dr. ChatGPT” (or even social media, which I rant about here⁷) for care instead of knowledgeable and ethical professionals. There’s actually a huge problem with people finding good care and small providers getting clients. Why? We now have venture capital companies.

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Venture Capital Companies

Just like the healthcare industry’s turn toward for-profit has resulted in massive monopoly-like companies that seem to be for the $$ instead of the people (I’m refraining from going into the assassination of a big insurance company’s CEO⁸), we are starting to see big venture-capital companies create telehealth mega-corporations that are fueled by profit instead of a motivation of healing. These telehealth companies are funded by investors who have no idea about medical/psychological ethics and procedures. But don’t worry…they have money… (inserts sarcasm). Containing my rant about this, I’ll just state that we’re hurting small businesses and profiting off of people’s pain and needs. Not good, guys. Not good at all.

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In 2024, we saw some disheartening trends. We’re in pain. We’re in a mental health crisis. We’re fed-up about it all and polarizing to cope. We’re re-examining constructs and power and privilege. And this coming year, in 2025, we need to get out of the victim mentality. We HAVE to start making changes that are ethical, empathetic, and beneficial to ALL people.

Are you going to be part of the change for good, or part of the problem?

Photo by LOGAN WEAVER | @LGNWVR on Unsplash

References

https://www.ft.com/content/e8ac09ea-c300-4249-af7d-109003afb893 ↩︎
https://en.wikipedia.org/wiki/Sean_Combs_sexual_misconduct_allegations ↩︎
Kleck, R. E., & Strenta, A. (1980). Perceptions of the impact of negatively valued physical characteristics on social interaction. Journal of Personality and Social Psychology, 39(5), 861–873. https://doi.org/10.1037/0022-3514.39.5.861 ↩︎
Jones, P. J., & McNally, R. J. (2022). Does broadening one’s concept of trauma undermine resilience? Psychological Trauma: Theory, Research, Practice, and Policy, 14(S1), S131–S139. https://doi.org/10.1037/tra0001063 ↩︎
https://mhanational.org/issues/state-mental-health-america ↩︎
https://www.aol.com/mental-illness-plagues-va-n-184111928.html ↩︎
https://www.personalitycouch.com/blog/whats-trending-in-our-culture/ ↩︎
https://en.wikipedia.org/wiki/Killing_of_Brian_Thompson ↩︎

Ep 12: Myths About Being a Mental Health Professional

Tue, 08 Oct 2024 02:00:01 +0000

In this episode of the Personality Couch Podcast, hosts we discuss common myths surrounding therapy and therapists. We debunk misconceptions about therapists being perfect, the necessity of shared experiences for effective therapy, and the idea that therapists are always analyzing everyone. The conversation emphasizes the importance of empathy, the reality of therapists’ personal struggles, and the motivations behind choosing a career in therapy. We also address the financial aspects of being a therapist and encourage listeners to seek help without being deterred by myths.

6 Myths About Mental Health Professionals

Tue, 08 Oct 2024 02:00:00 +0000

Historically, mental health and mental illness has held significant stigma, though we do seem to be moving in the right direction in destigmatizing it. However, there are still many misconceptions about therapy and therapists. Below are 6 myths that frequently come up in my experience as a psychologist.

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Myth: Therapists are all healthy and have no problems… They are perfect.

Hard no! Therapists are humans, and just like the rest of the humans, they are absolutely imperfect and have problems. Therapists have their own problems, and they can’t escape the human condition. Also like humans, they span the continuum from unhealthy to healthy. However, when therapists are in their professional setting, they are (supposed to) “container” their own problems, bias, and baggage, leaving it outside the therapy setting where they can pick it back up when done. The therapeutic relationship inherently creates a dynamic where the therapist’s “messy humanness” is hidden while they help a client’s “messy humanness.” The therapy space is for the client, so the therapist may seem “all put together” in the therapy space. But outside of that, therapists are just as messy.

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Myth: Therapists cannot help you if they haven’t experienced the same thing.

This is a sad falsity. It’s basically the question: “Can a therapist help you if they’re different from you?” That answer is absolutely. A therapist can’t experience everything that all their clients do - think about how many experiences, disorders, and variables that would be! Also, some experiences would be counterproductive to have, like a really unhealthy narcissistic personality disorder or acute schizophrenia. Then we also have the variables like age, race, parenthood, marital status, socioeconomic status, etc. For example, I’ve been told I’m too young to understand, which assumes my age, my entire life experience, and that my training is not sufficient despite age. Another example I’ve come across is the assumption that childless therapists can’t work with parents/kids. That’s phooey. They have the training. Also, would you assume a teacher, doctor, or caregiver can’t do good work with parents/kids if they were childless? There are some people who work with children because they don’t have their own - and they’re SUPER great at it. So not only is this myth unrealistic, but it undermines the research that states the relationship with the therapist is the most important common factor that positively impacts treatment.

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Myth: Therapists are always analyzing everyone.

This one is a bit more complicated, but it is still untrue. A therapist’s job is to analyze their clients, but when they’re outside of the therapy room, do they really have the energy to analyze everyone around them? Absolutely not. Now, let’s consider who is drawn to being a therapist. It’s likely the people who are observant, curious, helpful, and interested in understanding people. So therapists are more likely to be those things, but there’s also others who are not therapists who have those traits. The difference may be that therapists have the training, and thus the words, to express what they see outside the therapy room. But I genuinely believe that therapists don’t have the energy to always analyze. I think this myth stems from the notion that people become uncomfortable and want to hide their (dark?) humanness around three occupations: law enforcement, religious leaders, and therapists.

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Myth: Therapists have favorites/least favorites? Or my therapist probably thinks I’m crazy/burdensome.

This one is a no but also needs some explanation. Because both therapists and clients are humans, there is going to be some mismatches of personality or super great fits of personality. Just like your friend group, you are going to be drawn toward different people naturally and have difficulty connecting with other people. So this becomes more about relational factors rather than “favorites.” It’s not about the worth or value of a client; it’s about how you mesh with the client, which inherently means it’s about BOTH parties, not just one. So along those same lines, believing a therapist thinks you’re crazy or burdensome is also really unhelpful. Therapists chose their occupation and willingly signed up to help others, even those who may be complex or challenging. Plus, one therapist might find a client challenging while the next one does not. Again, it’s all about the match of the relationship.

Side note: I can’t help but wonder if this also stems out of transference in the therapeutic relationship. This is where the unconscious projects feelings that originate from primary attachments (i.e. parents) in childhood onto the therapist. So this becomes: “My mother found me burdensome; my therapist must too” or “I was my father’s least favorite of my siblings, so I must be my therapist’s least favorite client.”

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Myth: People become therapists because they want to work out their own issues.

This one is complex, and perhaps not a yes or no. No therapist is the same, and there’s so much diversity in the motivations of individuals who are drawn to the field of psychology. A standard response for “Why did you want to be a therapist,” is usually “to help people.” But there’s deeper layers to that, and therapists themselves may not even know the deep, unconscious answer. It may be that the therapist had mental health challenges and therapy, which they found valuable and useful, or maybe they saw someone close to them struggle with mental health and wanted to help. Neither are bad things. The “bad” part of this myth would be if the therapist’s own internal work was impacting a client’s treatment, and that means that boundaries would be crossed - that’s a bad thing. But whatever a therapist’s motivations are to be in the field, they can (and should) work on that outside the therapy space with no negative interference to their clients’ treatments.

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Myth: Therapists are all about the money.

This one is a hard no. The educational cost of becoming a therapist, paired with the low pay rate, does not equal a ratio anywhere near other health professionals. Psychologists are actually among the lowest paid of the highest educated professionals. Managed care contributes to this, as it’s quite imperfect. Insurance companies dictate the rates, and they’re not great. Plus, there’s risk and liability, which means paying for malpractice insurance and sometimes for legal assistance. Society is still wondering how much benefit psychology has to offer the medical field, though social media and the general public seems to feel differently. This hasn’t translated over to pay or value in the medical field or insurance companies.

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There are many, many more myths regarding therapy and therapists. At the core, I can’t help but wonder if these myths stem from resistance to therapy or perhaps even excuses not to try therapy. It’s okay if you’re not ready to try therapy, but please know that when paired with a good therapist for you, it can be extremely beneficial. Because these are myths and not reality. So when you’re ready, dive into therapy with a therapist you gel with. You’ve got this!

Ep 11: The Drama Triangle in Every Personality Disorder

Tue, 24 Sep 2024 02:00:01 +0000

In this episode, we dive into the concept of the drama triangle, a psychological model that explains interpersonal conflict through three roles: the victim, the persecutor, and the rescuer. We explore the historical context of the drama triangle, its origins in transactional analysis, and how these roles manifest in relationships, particularly in the context of personality disorders. Our conversation emphasizes the importance of recognizing these dynamics to disrupt unhealthy patterns and foster healthier interactions.

Where There's Smoke, There's Fire! Understanding the Drama Triangle

Tue, 24 Sep 2024 02:00:00 +0000

Remember that time when you were in that one super confusing, dramatic social situation? When that one person did that one odd thing, and that one dude said something you couldn’t believe, and you got pulled into it? Or think about all those reality tv shows and soap operas you’ve seen that are dripping in drama. Or the funky, smoky dynamics that occur with people at work or with a loved one… Well, certain personality structures/disorders are prone to drama…but what is drama? And why is it called a Drama Triangle?

♫ insert dramatic music ♫

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Where Did the Drama Triangle Come From?

The Drama Triangle came about after WWII when mental health professionals noticed that family factors played a part in the mental health of soldier’s reintegration into their family systems. Eric Berne, a psychiatrist during that time, believed social interactions contributed to an individual’s psyche, and he created a theory called Transactional Analysis. (This led to lots of other theories focused on family dynamics, including Murray Bowen’s concept of triangulation). Then we have Stephen Karpman, an actor turned psychiatrist, who studied under Eric Berne. Karpman was the one who coined the term and theory of the Drama Triangle in 1968. And we’re still using it 50 years later, especially in understanding personality disorder dynamics!

What is the Drama Triangle?

Karpman’s experience with theater drama led to his understanding of relational interactions (especially conflict) in terms of a triangle. The Drama Triangle includes power and destructive dynamics in the roles that people play in their interactions, as well as the possibility of people shifting roles. And, because it is a triangle with three sides, it focuses on three roles.

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Players in the Drama Triangle

Victim

The most important thing to understand about the victim role is that it is not synonymous with being an actual victim. Instead it’s someone who is feeling or acting like one. Their attitude is “poor me” or “woe is me,” a masochistic stance that pulls others to “save” them because they think they can’t take care of their own needs.

Persecutor

Again, it’s important to know that the persecutor role does not necessarily mean that the person is a villain, but that they take on the villain role OR are cast into the role by others. The persecutor’s stance is, “It’s all your fault, and it’s all about my needs.” Sometimes, this can be sadistic by lashing out or transferring blame or pain onto others. But other times, a person in the victim role can cast a person who doesn’t agree with their pain as a persecutor even though there’s no wrongdoing.

Rescuer

The rescuer role is the perceived rescuer, but they are oftentimes enmeshed enablers, taking the stance, “Let me help you.” There can be a sense of guilt if they don’t rescue, perhaps tied to being a “fixer” in childhood, avoider of their own problems (projection), or a narcissistic need to save another with their specialness.

Additionally, since nothing in life and relationships is simple, people don’t just stay in one role. People can move all around the triangle, which creates so much complexity and chaos! Different personality types usually have different patterns. For example, antisocial types tend to be in the persecutory role, but can also move into a victim role. Paranoid structures can move all over the three roles. Dependent types tend toward the victim role but can switch to the persecutory role. Narcissistic structures can be in the persecutory role and switch to rescuer.

PUBLIC SERVICE ANNOUNCEMENT
You’re setting yourself up for failure to think you can change anyone, no matter what role. If your happiness is contingent on someone else, you’re not going to find it.

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Stop, Drop, and Roll

So to detach from the drama dynamics and get out of the fire, you have to stop, drop, and roll.

Stop

The first step is to stop and observe what’s happening. Listen to your gut and acknowledge any confusion, cloudiness, fuzziness, lack of clarity, or chaos. Are you questioning reality and second guessing? Do you smell the smoke? Zoom out to see the big picture, like nonverbals and transactional behaviors. Stop and recognize that you’re in a drama, then figure out if you’ve taken on or been cast into a certain role.

Drop

The second step is to drop away from the fire. You’ve already figured out the players, so try to figure out what everyone is getting out of the dynamic so you don’t fuel the fire. Disrupt anything that reinforces the dynamic. Create and keep boundaries!

Roll

The third step is to roll out of the fire and into safety. Remove yourself from the triangle if possible. This might be anywhere from taking space for an hour (if it’s a mild dynamic) to completely getting out of the relationship (if it’s unsafe/abusive).

The main point of all this is to decrease the drama in your relationships, because let’s face it - it’s exhausting. So when you feel the funk in your interactions with others and smell something smoky, remember, where there’s smoke, there’s fire.

Ep 10: How We Diagnose Personality Disorders as Professionals

Tue, 10 Sep 2024 02:00:01 +0000

In this episode, we discuss how we diagnose personality disorders as licensed professionals in clinical practice. Personality data is often observed as early as the initial contact for treatment. Once treatment begins, we engage in a “meta process” of observing what’s going on inside ourselves as professionals, as well as the dynamic in the room. Because of the nuances and complexities of diagnosing personality disorders, psychological testing is an important tool to peel back the layers of the psyche. We end by discussing what psychological testing involves and point listeners to resources if they are interested in an evaluation.

How We Diagnose Personality Disorders as Professionals

Tue, 10 Sep 2024 02:00:00 +0000

Personality Couch is all about personality, including personality disorders (you can read about what personality disorders are here, here, or listen in podcast form here). Personality disorders are among the most difficult disorders to diagnose, especially because they are very complex and can be quite tricky. Personality is like a gobstopper - there can be multiple shells and layers and colors before seeing the core. So how is a personality disorder actually diagnosed??

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Personality disorders can be diagnosed by a mental health professional, but generally personality disorders require extra training or specialization to be competent in diagnosing and treating. Because of the complexity and relational nature of personality disorders (like being pulled into a drama triangle), psychological testing is extremely helpful for diagnostic information. What does this look like?

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Starting the Process

Data collection for testing (and therapy) starts at the first contact. This means the process of seeking care, filling out paperwork, and referral question(s) are all data to be sifted through - especially for personality dynamics! Does the client give any pushback on payment or policies? Take forever to fill out paperwork? Ask a bunch of questions like they’re suspicious/mistrusting? Immediately idealize or cross boundaries? When clients don’t follow the rules, there’s likely to be further difficulties in the later parts of the testing process. AKA: “Problems in the front = problems in the back.”

Further, the referral question or why the client is seeking testing at this time is also helpful data. Does the client have a ton of diagnoses that they dislike or disagree with and want clarification? Are they seeking to add on to their collection of diagnoses? Is there a history of multiple unsuccessful medication attempts (which points to possible misdiagnosis)? These are all questions to consider when personality factors may be at play.

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The Intake (and Initial Sessions)

To begin the process, there is an intake session where information is gathered. Besides the main questions involving things like symptoms, family dynamics, social functioning, or academic/occupational functioning, there are some more “invisible” variables to consider. Openness or how much information a client is willing to give (oversharing?) or not give (defensive?), as well as rapport, rigidity, nonverbals (facial expressions, voice tone), social scripts, and attachment (quick? intense? difficult?) are all important to pay attention to. It’s also helpful to assess for patterns of major ruptures in relationships and any personality drama triangle dynamics. While the verbal information collected is super necessary, it’s extremely important for providers to also listen to the information their gut is telling them.

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Psychological Testing

Psychological testing includes administering multiple research-backed tests to explore what is going on clinically. This is called a “battery,” and may include objective measures and/or projective measures (taps into what’s going on in the unconscious). Specifically for personality disorders, I love the Millon tests and projective tests. The data provided is assessed for things that are clinically significant, which means it’s meaningfully on the fringes or sidelines of “normal.” It’s also important to consider collateral data, as well as the provider’s own internal process and reactions. The provider then looks for themes in the data and creates a big picture from all the puzzle pieces. Of note, diagnoses should not be based on only one test.

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Feedback and the Report

The outcome of all this testing is presented in a formal report that includes diagnosis(es). It’s common to also have a summary of the findings as well as treatment recommendations and referrals. Though the process of the report presentation varies, it’s common that the report is provided after a feedback session. A feedback session is when the provider goes over all the data and information with the client and addresses any questions the client might have. Its main purpose is for the client to understand the findings and report.

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If you are interested in psychological testing, you can look on Psychology Today to find a qualified provider in your area. Our private practice, Quest Psychological and Counseling Services, offers psychological testing in Virginia. We specialize in “deep dive evaluations” with a special emphasis on personality dynamics and their function in the overall psyche. You can also check out what Quest offers here to better understand the evaluation process.

Ep 09: Cultural Trends and Mental Health

Tue, 27 Aug 2024 02:00:01 +0000

In this episode of the Personality Couch Podcast, we discuss four trends we have observed in the post-pandemic world: collective trauma, mental health diagnoses as identity labels, over-identification with neurodivergence, and self-diagnosing. We explore the impact of the pandemic on mental health, including increased anxiety and hostility. We also discuss how mental health diagnoses have become identity labels, providing a sense of validation and belonging. We delve into the over-identification with neurodivergence, particularly autism, and the challenges of diagnosing this condition. Lastly, we address the issue of self-diagnosing and the proliferation of misleading information on social media platforms.

Articles Podcast References

On Healthcare Workers’ Mental Health Symptoms:

https://blogs.cdc.gov/niosh-science-blog/2023/02/06/phw-violence/

On TikTok Mental Health Misinformation:

What’s Trending in Our Culture (and how it affects mental health)

Tue, 27 Aug 2024 02:00:00 +0000

As a psychologist in private practice, I constantly see how culture affects mental health. The cultural trends, both local and global, are often reflected in clinical work. People mold the culture, and culture molds the people. It’s a reciprocal dynamic, and in it, mental health is frequently found in the spotlight. I’m going to address four trends that have popped up since the pandemic ended.

Collective Trauma from Pandemic
Mental Health Diagnoses as Identity Labels
Overidentification with Neurodivergence
Self-Diagnosing

Then I’ll talk about what can be done about them, and you can find more information about it in this podcast!

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Collective Trauma from Pandemic

While everyone has different experiences and reactions related to the pandemic, now that we are post-pandemic, there are some overarching cultural themes emerging. Because of the unpredictability and utter chaos of the pandemic, overall anxiety has increased. It’s likely a trauma reaction, as we are all “on edge” for the world to erupt into crisis again - not because it necessarily will - but because that’s how trauma works. We’re hypervigilant and more easily in our fight or flight (or freeze or fawn) trauma responses.

The instability of our world during the pandemic has also led to a distrust of authority/power. How can we trust the people in authority and power when it seemed that no one could help stabilize us, and when there was conflicting information everywhere? I personally think that because there was so much conflicting information - even medical information, there’s just an overall distrust of doctors and medical authorities, which include psychologists. It seems that patients are now the “experts” with all the research at their fingertips - which makes sense as a protective coping mechanism against medical authorities who may or may not be trustworthy. However, it’s extremely unhelpful when diagnosing and treating mental health.

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Additionally, hostility seems to have increased significantly, which I think is also a nod toward increased stress as well. Anecdotally, I see this everywhere from driving to social media to visits to the grocery store. Research-wise, one study found that during the pandemic about one third of public health workers experienced some form of harassment, threat, stigma, and even violence in the workplace. Because of the scarcity of adequate care (especially during the pandemic), our need for immediate gratification has increased. We want our appointments and treatment NOW, and we want our providers to fix us NOW. This has resulted in the increased burnout and mental health symptoms (i.e., depression, anxiety, PTSD, suicidal ideation) in workers in the healthcare field. The pandemic has drastically changed the healthcare field, inside and out, and all around.

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Mental Health Diagnoses as Identity Labels

Not too long ago (though I may be showing my age), the psychological field went through a movement of separating labels from one’s person. For example, I was taught to say, “the person with schizophrenia” instead of “the schizophrenic,” or “my client on the spectrum” instead of “my autistic client,” or even “you’re feeling angry” instead of “you’re angry.” This movement may still exist in writing words, but not with identity. Psychological diagnoses seem to be worn as badges of specialness wrapped up in identity. People are more apt to say, “I’m ADHD” instead of “my ADHD symptoms…” Why? I think we’re finding specialness in our pain. Voices are often lost in the masses, but if heard and seen, even through a diagnostic label, then maybe it won’t hurt so much. The problems with this is that the mental health struggles faced are now part of the person (ego-syntonic) instead of outside the person (ego-dystonic). Growth is thus hindered as a result. Think about it: If I identify as depressed, how can I expect to grow and change and cope with it? It’s who I am. BUT if I am experiencing a depressive episode, I can more easily internalize that it’s a season of life that I can handle with skills and help. I don’t need to be stuck on the awareness of depression or the label of depression. I can move past the label and start working on my journey toward health.

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Overidentification with Neurodivergence

In the 1990s, neurodivergent became a term to describe neurological traits that differ from “normal.” Because of the brain and neurological components, disorders such as autism spectrum disorder, ADHD, and learning disorders fall into this category. A little statistics: When doing research, it is common to consider that 95% of cases are within “normal” boundaries, with 5% of cases outside of the norm (or within 2 standard deviations of the average). Now this is cut in half, because 2.5% of cases are going to be way lower than the norm and 2.5% of cases are going to be way higher than the norm. Neurodivergent means outside of the norm. Theoretically, this means that no more than 2.5% of individuals are diagnosed with autism spectrum and no more than 2.5% of individuals are diagnosed with ADHD. The DSM-5-TR notes that 1-2% of people are on the autism spectrum and 2.5% of adults are diagnosed with ADHD (though children/teens range from .1 - 10.2% depending on the country). The overidentification with neurodivergence, paired with having a diagnostic label as an identity, is extremely problematic. Just go on social media - there are way more than 2.5% of people self-diagnosing as neurodivergent.

Also of important note: the DSM-5-TR criteria for Autism Spectrum Disorder has changed to be more clear: https://www.wpspublish.com/blog/dsm-5tr-updates-autism-diagnostic-criteria. Additionally, previous editions did not provide the following clarity about early development, instead prescribing that symptoms are present before age 3. According to the DSM-5-TR, “Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies later in life” pg. 57). Notably, the culture seems obsessed with this concept of “masking,” but is missing the point that autism is a disorder of early childhood development. Masking in this context is not mutually exclusive to this being a disorder that shows up early in life.

Self-Diagnosing

This has all led to, in my own opinion, the most problematic post-pandemic trend: self-diagnosing. It’s likely people are diagnosing themselves because of a combination of collective pandemic-related trauma, need-it-now mentality, overtaxed healthcare system, distrust of authorities, and search for identity/validation of pain found in mental diagnostic labels. The pandemic resulted in isolation and disruption to communities, so it makes sense that people can now find communities (i.e., neurodivergent) online and in social media. People like to surround themselves with social media “examples” supporting their self-diagnosis. Being in community is great! But social media is misleading…

Photo by Jaron Nix on Unsplash

This article highlights the misleading and “potentially damaging” influence of social media, which they referenced from this study regarding TikTok videos on mental health. Here are the main points:

Mental Health Advice
- 54% had accurate information
- 31% had inaccurate information
- 83.7% had misleading advice
- 14.2% include “potentially damaging” content 🚩🚩
Misleading Mental Health Information
- 100% of ADHD content 🚩🚩🚩
- 94.1% of bipolar disorder content
- 90.3% of depression content
Relevant Medical Qualifications of TikTokers
- 9% were qualified 🚩
- 91% were NOT qualified

Photo by Olivier Bergeron on Unsplash

⚠️Sooooo, basically it’s not good to self-diagnose or rely on TikTok for mental health information.⚠️

So What Can We Do?

We can aim to grow toward more healthy behaviors, thoughts, emotions, and patterns. Be aware that the pandemic likely affected you in a unique way, and it’s okay to seek help. Work on increasing self-awareness and self-reflection. Talk to someone, and if there’s a waitlist, get on it despite the frustrations with timing. Practice patience. Understand that critical thinking is absolutely necessary AND that most therapists are trustworthy as well. It’s a great idea to increase those critical thinking skills. Ask yourself, “What does getting this diagnosis mean?” Ask yourself - “Does it pass the smell test?” Cross-reference your data and seek accurate information. Find guidance from QUALIFIED mental health professionals (Like the Personality Couch). Try to find community and identity that is not related to mental health. Because You. Are. NOT. Your. Diagnosis. You’re you, and that is a wonderful thing.

Photo by Alysha Rosly on Unsplash

Ep 08: Enneagram Personality Classifications

Tue, 13 Aug 2024 02:00:01 +0000

In this episode of the Personality Couch Podcast, we provide an overview of the Enneagram personality typology as a growth tool instead of a personality “box” or label. We discuss our personal journeys with the Enneagram, our typologies, and how we use this non-diagnostic tool in clinical practice. By exploring the different centers of intelligence (body, head, and heart) and the three types within each center, we highlight the key characteristics and tendencies of each of the 9 types, including their strengths and challenges.

Enneagram Personality Classifications

Tue, 13 Aug 2024 02:00:00 +0000

The purpose of this blog is to provide a beginner’s level overview of the Enneagram. While simple on the surface, the more you dig, the more complex and intriguing this conceptualization of personality becomes. So, just in case you want more (because why the heck wouldn’t you 😉), I’ll put some more resources at the bottom to help you dig deeper. For now, let’s start with the image of the Enneagram.
As you can see from the image above, the Enneagram is visually represented by a complete circle with 9 points connected by lines or “paths.” The “ ” part of the word means nine and the “ ” part of the word means drawing or model. Thus, the enneagram literally means a 9 point drawing, and those 9 points represent 9 styles of personality and are encompassed in one circle (circle represents unity/wholeness). These 9 styles are not isolated, but in connection with each other - somewhere between categorical and dimensional.

Types

The Enneagram uses numbers to describe categorical styles of personality because there is no positive or negative connotation for numbers like there are for words; no personality is more or less valuable/better than another. Each personality has strengths and weaknesses. Over time, however, we have assigned some basic words to each type. Additionally, it is mostly agreed that we are born with a dominant personality style that helps us interact with our world and develop, and that core personality does not change to another style, though we can grow and adapt. There is also a concept of a that influences personality development. Further, you won’t perfectly fit into your core personality style all the time because of growth, stress, health, and other environmental factors.

Now, this is where the Enneagram becomes super complex. Within each type, there is a continuum of health or “ ,” three different based on instinct (creating 27 types), and . I’m not going to go into the levels of development because it’s basically a continuum from unhealthy to healthy. The three different subtypes of each personality include the following instincts: self-preservation, sexual, and social. Self-preservation (Sp) highlights a focus on maintaining life, self-protecting, and surviving. The sexual instinct (Sx) focuses on relationship and attachment to create generations. The social instinct (So) values social connection and secure bonds to others. Thus, for example, a Sp 2, Sx 2, and So 2 are going to be quite different. Next we have wings, which are controversial in the literature regarding both its existence (or nonexistence) and functioning. Without going too deep, wings are which style you lean toward next to your own. For example, a 1 can be a 1w9 or 1w2; a 2 can be a 2w1 or 2w3; and a 3 can be a 3w2 or 3w4. Remember, wings can only be the number before or after your own number.

Type	At Their Best	At Their Worst	Struggle	Ideal
1 ONE	●Honorable ●Idealistic ●Virtuous ●Conscientious	●Judgmental ●Critical ●Controlling ●Rigid	Anger	Serenity
2 TWO	●Caring ●Considerate ●Helpful ●Passionate	●Manipulative ●Selfish ●Martyr-like ●Ambiguous	Pride	Humility
3 THREE	●Confident ●Pragmatic ●Vigorous ●Positive	●Superficial ●Vain ●Fraudulent ●Grandiose	Self-Deceit	Truthfulness
4 FOUR	●Artistic ●Empathetic ●Reflective ●Emotional	●Moody ●Egotistical ●Detached ●Ashamed	Envy
5 FIVE	●Logical ●Perceptive ●Objective ●Sensitive	●Passive ●Cold ●Stingy ●Pessimistic		Non-Attachment
6 SIX	●Capable ●Dependable ●Steadfast ●Supportive	●Cantankerous ●Erratic ●Oppositional ●Suspicious	Fear	Courage
7 SEVEN	●Charismatic ●Sunny ●Exuberant ●Assured	●Self-absorbed ●Impulsive ●Inconsistent ●Unruly	Gluttony
8 EIGHT	●Straightforward ●Dynamic ●Down-to-earth ●Protective	●Aggressive ●Crass ●Dictatorial ●Selfish	Lust	Innocence
9 NINE	●Acceptant ●Calm ●Gracious ●Harmonious	●Inattentive ●Zoned out ●Indifferent ●Passive-aggressive		Action

Centers

The Enneagram has three centers. The body center contains instincts felt in the gut and is focused around anger, which encompasses the 8, 9, and 1 personality styles. The heart center contains feelings/emotions and is focused around shame, which encompasses the 2, 3, and 4 personality styles. The head center contains thinking/cognition and is focused around fear, which encompasses the 5, 6, and 7 personality styles.

Within each of these centers, the three different types interact differently with the center’s focus. In the heart center, 2s overdo or express their shame outwardly, 3s underdo their shame and hold it all in, and 4s are conflicted about their shame and turn it inward but run from it. In the head center, 5s overdo or express their fear outwardly, 6s underdo their fear and hold it all in, and 7s are conflicted about their fear and turn it inward but run from it. In the body center, 8s overdo or express their anger outwardly, 9s underdo their anger and hold it all in, and 1s are conflicted about their anger and turn it inward but run from it.

Growth and Stress Pathways

Again, the complexity and dynamic nature can be found in the pathways between types. The pathway of growth or “ ” means that when we are in relaxed and balanced conditions, we move toward health/growth by taking on some of another type’s traits. The pathway of stress or “direction of disintegration” means that when we are in stress (external or internal) we move toward less helpful/resourceful traits of another’s type. Notice that types 3, 6, and 9 (9-3-6-9) are connected, moving clockwise around their triangle in growth and counterclockwise in stress (9-6-3-9). The other types then follow the growth pattern of 1-7-5-8-2-4-1 and go backward in the stress pattern of 1-4-2-8-5-7-1.

There are so many other facets and pieces of the Enneagram that weren’t discussed here. My favorite part about the Enneagram is its dynamic nature. One 5 is not going to look like another 5, though there will be commonalities, due to variables like wings, growth/stress pathways, instincts/subtypes, and levels of development. I like to think about it like this ball of color hues - everyone falls a little differently on it. While there are categories because our brains chunk information to understand, all the main colors contain so many variations!

To learn more about the Enneagram, see these resources for more information.

References

by Elizabeth Wagele and Renee Baron
by Ian Morgan Cron and Suzanne Stabile
(Faith-Based) by Don Richard Riso and Russ Hudson
(Faith-Based) by Richard Rohr and Andreas Ebert
by Beatrice Chestnut
by Don Richard Riso and Russ Hudson

Please also note that Quest may earn an affiliate commission should you choose to buy books through these links. Any commission goes back to Quest and allows us to keep serving our community by going above and beyond!

Ep 07: Personalities That Kill

Tue, 30 Jul 2024 02:00:01 +0000

In this episode of the Personality Couch Podcast, we discuss personality darkness and specifically focus on personalities that are prone to violence and extreme behavior. We also discuss two important research studies, the Milgram study and the Stanford prison experiment, that shed light on the capacity for humans to engage in harmful acts. We then delve into the different personality types within Cluster A (schizoid, schizotypal, and paranoid); Cluster B (borderline, histrionic, and narcissistic); and Cluster C (avoidant, dependent, obsessive-compulsive) and discuss their risk levels for violence and murder. In this conversation, we also explore sadistic personalities, a category not included in the DSM, but included in multiple other personality theories. We highlight the characteristics and behaviors associated with each type and discuss the potential for violence and destructive behavior. The conversation emphasizes the importance of understanding these personalities and their potential risks in order to promote awareness and better understanding of human behavior.

Personalities That Kill

Tue, 30 Jul 2024 02:00:00 +0000

One of my favorite topics to dive into is the darkness of humanity and thus the darkness of personalities. Harm to others surrounds us in a ridiculous amount of ways, which makes many people think about not only what others around them are capable of, but of what they, themselves are capable of. The popularity of true crime, dark genres, horror media, etc., provides evidence that people are interested in this topic. And of course, there’s always some recent event that can remind us of the darkness people have in them. There is SO much I could say about this topic (Listen to podcast episode 07 for much more information), but for now, I’m just going to address the question:

🚩What personalities are at the most risk to kill? 🚩

In my opinion, there are three main personality types that fall into the high risk category. I’m going to start with the “least” risky and end with the “most” risky, though please remember that all still are at high risk.

Narcissistic Personalities

Medium Risk to High Risk

Photo by Lance Reis on Unsplash

The thing to remember about narcissism is that those who kill are quite likely to at least have high narcissistic traits, but not necessarily a narcissistic personality structure/disorder. Narcissistic personalities are all about image, ego, and the self, needing admiration and presenting with superiority, grandiosity, and charm (see Episode 04 podcast/blog for more info on narcissistic personalities). They value image so much that they can harm others in their pursuit and maintenance of it. However, there are some types of narcissistic personalities that are at higher risk for actually killing. While some narcissistic personalities are “more pure,” their focus on image is mostly about climbing the social ladder (e.g. Elitist subtype from Millon, p. 397). Now, they’ll react with anger, hostility, and even emotional/verbal abuse, but they’re not apt to physically kill. In contrast, there are some types who connect power with image, resulting in destruction. Millon’s “Unprincipled” subtype of narcissistic personality (Millon, p. 402) is at high risk for killing due to lack of remorse, lack of social conscience, vengefulness, and maliciousness. This subtype includes antisocial features, seen in their desire to humiliate and dominate others. Millon’s “Unprincipled” narcissist seems to be similar to the PDM-2’s mention of the “Malignant” narcissist (PDM-2, p. 46), whose narcissism is combined with sadistic aggression… 🚩Yikes!!

Photo by Tech Nick on Unsplash

Paranoid Personalities

High Risk

Paranoid personalities are tricky. You never really fully know a paranoid personality since they show different faces to different people, which they do because they are suspicious, distrustful, and fearful of others and the world (see Episode 04 podcast/blog for more info on paranoid personalities). They view the world as threatening and against them, and in their defense against this, they tend to attack before being attacked. They can’t handle their own pain and so they transfer it onto others, often in a dramatic manner. They are at a very high risk for destroying others and then themselves, while projecting their own pain onto the masses - such as in a murder-suicide event. It wouldn’t surprise me if many mass murderers have paranoid personality structures. However, while unhealthy paranoid personalities are dangerous in general, some might be most dangerous to themselves (Millon’s “Insular” subtype, p. 975) or in other ways outside of murder (Millon’s “Fanatic” subtype, p. 983). In contrast, Millon’s “Querulously” subtype (Millon, p. 974) tend to be hostile and have delusions, often erotic ones that can result in behaviors like stalking, killing for their object of infatuation, or even killing their actual object of affection. More concerning is Millon’s “Malignant” subtype (Millon, p. 987) who tend to be previous sadistic types who have “fallen apart.” …🚩🚩No bueno!

Antisocial Personalities

High Risk

Photo by Sander Sammy on Unsplash

Antisocial personalities are boundary-crossing, as they tend to disregard and violate the rights of others, social norms, and the law. They are often deceptive, sneaky, and charming on the outside, but can also be impulsive, aggressive, and/or reckless (see Episode 04 podcast/blog for more info on antisocial personalities). In my opinion, antisocial personalities can be somewhat less dangerous than sadistic personalities, because there are some types who are more at risk for harm to themselves (Millon’s “Risk-Taking” subtype, p. 451) or just withdrawal from society (Millon’s “Nomadic” subtype, p. 455). In contrast, Millon’s “Reputation-Defending” subtype (Millon, p. 453) is high in narcissism as well, with a focus on looking tough and powerful with high status. They might have positions of power and rule with aggressive leadership, likely finding a place in extremist groups/cultures. They are very likely to engage in violent acts to “confirm” their own strength, viewing their victims/enemies as the wrongdoers, which they feel condones their violence.

Millon’s “Malevolent” subtype (Millon, p. 458) is perhaps one of the most dangerous personality types, especially as they are paired with paranoid or sadistic features. They tend to be revenge-driven, vindictive, hateful, and destructive. Millon’s bone-chilling description of them on p. 458 includes the statement, “Distrustful of others and anticipating betrayal and punishment, they have acquired a cold-blooded ruthlessness, an intense desire to gain revenge for the real or imagined mistreatment to which they were subjected in childhood.” …Even more scary, they can usually grasp the concept of remorse/guilt in their minds and even experience it emotionally, but they disregard it🚩🚩🚩. This type seems to be the one that comes to mind when we hear the word “psychopath,” and interestingly, it seems to correlate with the PDM-2’s “Aggressive” subtype of antisocial personality (PDM-2, p. 50).

Sadistic Personalities

High Risk 🚩🚩🚩🚩

Photo by Kurt Cotoaga on Unsplash

This category of personality is a bit confusing. The DSM-5-TR does not include sadistic personality disorder, but Millon and the PDM-2 separate sadistic and antisocial personalities. The overall core of sadistic personalities is their enjoyment of inflicting pain on others (see Episode 05 podcast/blog on Millon’s types or Episode 06 podcast/blog on Psychodynamic types for more info on sadistic personalities). Some sadistic personalities feel like they are entitled to control or punish others, often taking positions of power in militaries, schools, or legal systems, as they also have some compulsive traits. Their power leads to feelings of arrogance and superiority, resulting in a tendency to view their “victims” as inferior and maybe not even human - but all this is wrapped up in their “righteous” exterior that they portray as moral (Millon’s “Enforcing” subtype, p. 637). Some sadists are actually very fearful and use violence to disguise their fear, moving against it through counterphobic action. They can be quite cruel and often find themselves in groups with a shared victim, like a hate group - somewhere to put their anger about their own weakness (Millon’s “Spineless” subtype, p. 637). Some might possibly kill those closest to them in an uncontrollable and unpredictable rage that tends to not be premeditated but impulsive. (Millon’s “Explosive” subtype, p. 641).

The one I find the most severely brutal and horrifying is Millon’s “Tyrannical” subtype (Millon, p. 642), which can have paranoid and/or negativistic features. They enjoy destroying, abusing, assaulting, and terrorizing. They are the devious, composed predators who seek out weak prey, and when they attack, they do so with no remorse, unable to stop until their rage is exhausted. Millon states, “What is also especially distinctive is the desire and willingness of these sadists to go out of their way to be unmerciful and inhumane in their violence” (Millon, p. 645), adequately describing them as being “distressingly ‘evil’” (Millon, p. 642).

Hopefully, this helps you better understand your true crime shows and villains in the media you consume. I wouldn’t wish a relationship with these risky types on anyone! It gives a bit of a new meaning to the concept of red flag 🚩. Beware and be well!

References

Psychodynamic Flavors of Personality

Tue, 23 Jul 2024 06:00:00 +0000

If you remember from the 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, , the , Second Edition ( ) contains even more categories and includes subtypes of personality. Also note that the PDM-2 has more personality types than we highlighted in our .

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 ( , , , , etc) and the term “ ” 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 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 “ ” instead of to describe this type of personality, which makes sense because, as stated in the PDM-2, these individuals are not necessarily against social norms ( ), nor are they incapable of social interaction ( ). 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 . 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 and , 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 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 .
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 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 has been utilized in many ways within psychology, but all include an (unconscious) investment in suffering. While the DSM previously considered , 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).

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.

Ep 06: Psychodynamic Personality Classification (As Ice Cream)

Tue, 16 Jul 2024 02:00:01 +0000

In this episode of the Personality Couch, we discuss personality flavors and typologies from a psychodynamic lens, using ice cream as our metaphor. Unique to the psychodynamic perspective is the multi-dimensional way it captures personality. We explore psychodynamic’s three personality axes throughout the episode: the severity axis (ranging from personality style to disorder level); the organizational axis (representing movement and disintegration within personality structures); and the character axis (representing distinct personality names and characteristics). We further explore psychopathic, schizoid, depressive and manic, self-defeating, borderline/cyclophrenic, and dissociative personality structures within this framework. A note to our audience: this is a complex and deep topic, and we recommend tuning in to episodes 04 and 05 first: Personality Disorders as Ice Cream Flavors and Millon’s Personality Types (as Ice Cream flavors) first before diving in. Alternatively, you can check out our blogs with visual aides here to guide you: Blog: Psychodynamic Personality Classification (As Ice Cream)

Psychodynamic Personality Classification (As Ice Cream)

Tue, 16 Jul 2024 02:00:00 +0000

Photo by Evaldas Grižas on Unsplash

Psychodynamic theory views personality a bit differently than both the DSM and Millon. The Psychodynamic Diagnostic Manual, Second Edition (PDM-2) “aspires to be a ‘taxonomy of people’ rather than a ‘taxonomy of disorders,’ and it highlights the importance of considering who one is rather than what one has” (PDM-2, p. 2). The PDM-2 has thus expanded personality categories, which resulted in a multidimensional approach to personality. While the PDM-2 uses multiple axes, we’re going to talk about the one specifically measuring personality. Visually, it’s helpful to see how this “Personality Axis” contains other axes that work together… And as always, we use ice cream to help make this complex topic more “digestible!”

The Diagnostic Severity Axis: Amount of Ice Cream and Ingredients
The Organizational/Health Axis: State Change of Ice Cream
The Character Axis: Flavor Category of Ice Cream

Let’s look at each one and see what it contributes to our understanding of personality!

The Diagnostic Severity Axis: Ratio of Ice Cream and Ingredients

We all have a personality. The severity axis is a continuum that shows how functional your personality is to how problematic it is. Are your personality traits serving you, working against you, or even keeping you from functioning in society? It’s not categorical, because we all move along this continuum at certain times, but usually we stay in a small range of the continuum. If it’s not clinically distressing or impairing, it’s toward the Structure end of the continuum. The more problematic, the further toward the Disorder end you might be. Let’s look at it through an ice cream lens!

We might think of this axis as the ratio of ice cream to the bowl or cone. Do you have enough ice cream to fill your bowl? If you have too little ice cream, or certain personality traits, you might have a psychological empty spot that you try to fill with other things (i.e. spending, love, indiscriminate partners, substances, food). If you have too much ice cream, is it overflowing onto others or about to fall off the cone because it’s hard to balance? We can also think of the ratio of flavor and ingredients in the ice cream. Is there too little flavoring to actually taste it, or is there too much flavor? Eating a drop of vanilla extract is gross, but put an appropriate amount in the ice cream, and it’s delicious! Same with ingredients. If there’s too little of certain ingredients in your ice cream, it’s like having pretty significant personality deficits that make it hard to function in our social world. If there’s too much of certain ingredients, it’s overwhelming, and the excessiveness of certain “flavors” or personality traits don’t fit into society well either. So this axis is all about balance and functioning!

The Organizational/Health Axis: State Change of Ice Cream

Early in psychology’s journey of conceptualizing personality, there were two categories: psychotic and neurotic. Eventually, someone discovered that not everyone fits neatly into two categories (😱🤯). Some theorists called those who did not fit in either category: “Borderland.” This term was later adapted to become a continuum from psychotic to neurotic, with the space in between called “Borderline.” (Note: The borderline movement in the continuum was forced back into a category for the DSM-III’s Borderline Personality Disorder - an unfortunate move in our field).

On the continuum, the further we are on the neurotic side, the more rigid and frozen we become - sometimes even literally! The ice cream might become freezer burnt or even just become ice with its atoms super close together and structured. It’s hard to scoop out this ice cream and may be painful. The psychotic part of the continuum (melted) is when we are out of touch with reality. The ice cream has melted and is now liquid. Its original state is lost, just like reality. Then there’s the big space in between called borderline (melting) where we might start to melt. We are still ice cream, but we might be falling apart and melting when we start moving toward the psychotic end. And when we move back toward the neurotic end, the melting is refrozen and icy. We can move along this continuum because we’re not static beings. Even when healthy, we can have snippets of disintegrating or moving toward unhealthy. This organizational axis is essentially an axis of health, but we still don’t want extremes.

The Character Axis: Flavor Category of Ice Cream

The character axis is the actual type/flavor of ice cream. While this seems more categorical for the purpose of understanding and learning, it’s important to note that in actuality, you are rarely only one type of personality. In fact, it is common for literature to talk about mixed personalities. Using our ice cream analogy, this might look like a matcha ice cream with a strawberry swirl and a scorpion on top (paranoid-schizoid), a burnt marshmallow ice cream with cookie dough bites (melancholic-dependent), or a cotton candy ice cream with ghost pepper pieces (histrionic-narcissistic). The flavors are endless - just like individual personalities!

So this is a great place to remind you that while we categorize and label personality information into neat boxes in order to understand and better “consume” the study of personality, limiting yourself to fit into a box is not helpful. The study of personality helps us to identify patterns and concepts, but it falls immensely short of describing an individual person. You are your own unique flavor, and that is something wonderful!

References:

Lingiardi, V., & McWilliams, N. (Eds.). (2017). Psychodynamic diagnostic manual: PDM-2 (2nd ed.). The Guilford Press.

Ep 05: Millon's Personality Types (As Ice Cream Flavors)

Tue, 02 Jul 2024 02:00:01 +0000

In this episode, we continue discussing personality typologies, focusing on Dr. Theodore Millon’s classifications. We explore six unique types in terms of their characteristics, behaviors, and potential co-occurring disorders. Speculating on what ice cream flavor each type would be, we use creative and humorous descriptions to bring levity to an otherwise complex topic!

Millon's Personality Types (As Ice Cream Flavors)

Tue, 02 Jul 2024 02:00:00 +0000

Photo by Ho Hyou on Unsplash

As with all conceptualizations and theories, none are fully complete. So, here we discuss additional personality “flavors” established by the great Theodore Millon. Millon’s work greatly influenced the DSM-III, and he was involved in updating more recent editions of this diagnostic guidebook. The following personality typologies are not diagnoses, but they are still extremely helpful in understanding personality, and we frequently use them in psychological testing! Millon’s theory includes a continuum of severity, ranging from Style to Type to Disorder level. Millon’s expansive understanding of personality is absolutely invaluable both clinically and personally. And of course, we continue with the ice cream theme because – well, why not? #FunAndNerdy

Melancholic

Photo by Amanda Kloska on Unsplash

If you know what the word melancholy means, you can probably guess the overall features of this personality flavor. I like to call it the Eeyore personality, though in the DSM-IV and DSM-IV-TR it was listed in the appendix (aka further study needed) as Depressive Personality Disorder. And previous to that, it was dysthymic disorder, and now persistent depressive disorder. If major depression was a storm overhead, and persistent depression a fog, this type of depressiveness is a constant gray cloud that is intertwined with the entire self, and it stays put even if you’re sitting in glittery rainbows with an adorable puppy on your lap. Like Eeyore, melancholic types have a passive defeatist or giving up character that sits in the pain of life and rejects life’s pleasure.

So if Melancholic Personality was an ice cream, it would be Burnt Marshmallow – a gray flavor that wants to be sweet but is tainted by the burning pain of life. There is no joy in this ice cream. It doesn’t even look appetizing, but it’s non-threatening and just stays in its own untouched corner of the ice cream shop.

Turbulent

Photo by Jeswin Thomas on Unsplash

In contrast to Eeyore, Turbulent Personality is Tigger. It’s all about energy. They bounce from activity to activity, looking for stimulation and new things, as they are easily bored. They are enthusiastic toward life, actively seeking pleasure in life (opposite of Melancholic), and coming off as overly animated, joyful, passionate, and optimistic. They have a ton of energy, but they are still human, so they sometimes spend so much energy, they crash into a depressive recovery period before bouncing back up and going full speed again. It’s like a roller coaster of energy and emotions. It can sometimes look similar to hypomania, but instead of being an organic biological event, Turbulence is an ingrained temperament. It’s like, Turbulent Personalities are wired to view life as a rollercoaster and enjoy it, though it naturally comes with lows, while those with hypomania might feel someone cast them on a rollercoaster for a little bit without consent.

If Turbulent Personality was an ice cream, it would be “Everything and the Kitchen Sink” – a coffee based ice cream with sprinkles, Fruit Loops, fudge, cookies, icing, gummy bears, M&Ms, etc. It’s a toddler’s dreamland that is sickeningly sweet and results in an intense sugar crash. Or it could even be a “flavor flight” with little cups of all the flavors because it is imperative to try them all. All the experiences are needed.

Sadistic

Sadistic Personality Disorder was included in the appendix of the DSM-III-R (1987) as a condition for further study, but was taken out in the DSM-IV. This proposal was due to observation of patients, often in forensic settings, who were cruel, aggressive, demeaning, and lacking in empathy, who did not fit into other DSM personality categories – including Antisocial. Remember, Antisocial is going against society and actively putting themselves first. While Sadistic Personalities inherently can go against society, the main difference is that they find pleasure in imposing pain (cruelty, stress, fear) on others. They revel in the satisfaction of tearing others down, humiliating others, watching others suffer, and hurting others. Of note: Sadistic Personality does not necessarily mean sexual sadism and vice versa.

If Sadistic Personality was an ice cream, it would be something that looks just like ice cream but is actually glue and arsenic. The individual with a Sadistic Personality is then going to sit in the corner of the ice cream shop and find immense pleasure in watching others eat their poisonous trickery.

Masochistic (Self-Defeating)

Photo by Žygimantas Dukauskas on Unsplash

Just like Sadistic Personality, Masochistic Personality Disorder (changed to Self-Defeating) was proposed for further study in the DSM-III-R (1987) and dismissed in the DSM-IV. In both Sadistic and Masochistic Personalities, experiences that would usually be pleasurable are actually painful, and experiences that are normally painful are felt as pleasurable - a reversal of pleasure-pain dynamics. Similar to how Sadistic Personality types would find pleasure in actively imposing pain onto their partner, a Masochistic Personality type would find pleasure in passively accepting the pain received. Because of this, Sadistic and Masochistic Personality types often gravitate toward each other. The Masochistic Personality type tends to unconsciously set themselves up for pain, failure, or difficulty. They self-sabotage, not necessarily enjoying suffering, but needing to suffer to feel like they exist. We could use Ariel from the Little Mermaid to demonstrate the choice to suffer without a voice so that she can exist in the world she desires. In this story, Ursula would be the Sadistic personality type.

In keeping with the ice cream theme, an individual with a Masochistic Personality would not even make it to the ice cream shop due to self-sabotage. Maybe they didn’t make the trip or unconsciously timed the trip to arrive just after the store closed. If they did arrive in time, they would offer to lick up the leftover ice cream with their tears mixed in, believing they didn’t deserve ice cream anyway. They are positioning themselves to do without or to suffer.

Negativistic (Passive-Aggressive)

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Negativistic Personality has a very interesting history. It showed up in the first edition of the DSM (1952) as passive-aggressive personality disorder, passive-aggressive subtype. (There was also a dependent subtype and aggressive subtype). Then in the DSM-IV (1994) it was moved to the appendix for further research and renamed Negativistic Personality Disorder. It was removed and excluded from the DSM-V.

The main struggle of those with a Negativistic Personality is the conflict between acting on their own behalf versus acting for others. They actively shift back and forth between people-pleasing and putting themselves first. Similarly, they also shift between being irritated that they are not addressing their own needs and feeling guilty and fearing the loss of support from others. They alternate between compliance and defiance, leading them to be grouchy, mistrusting, skeptical, and pessimistic. They tend to feel like life isn’t fair, and it’s everyone else’s fault, not their own.

As an ice cream flavor, Negativistic Personality would be all the bitter things. Perhaps an apple cider vinegar ice cream with grapefruit, kale, and sardines. The sardines would still have the bones in them because of the prickle-y-ness of this personality type. And to capture the grumpiness and antagonism, it would be dyed green like Oscar the Grouch.

Compulsive

(Obsessive-Compulsive Personality)

Photo by pariwat pannium on Unsplash

Like Negativistic Personalities, Compulsive Personalities also have a conflict between acting for themselves or others; however, the Compulsive individual stuffs all their own needs down and devotes themselves to meeting others’ needs. But to make sure that their needs stay stuffed down, and to avoid criticism, they can be overly and passively people-pleasing and indecisive. They are extremely socially compliant and respectful of others, but they tend to have un/subconscious desires to rebel.

Compulsive Personality Disorder actually showed up in the DSM-I (1952) and DSM-III (1980), changing to Obsessive-Compulsive Personality Disorder in the DSM-II (1968) and DSM-III-R (1987). It has remained Obsessive-Compulsive Personality Disorder since then. While there is considerable overlap between Millon’s Compulsive Personality and the DSM’s Obsessive-Compulsive Personality, they are different in that Millon’s understanding is more about pleasing others while stuffing down all their own needs, resulting in a desire to rebel. The DSM’s definition focuses on the perfectionistic rigidity that is placed onto others in this condition.

The Compulsive Personality would be an espresso ice cream with 2.2 grams of sugar, and would be gluten free, keto-friendly, paleo-friendly, and somehow vegan. It’s perfectly symmetrical and does not drip. Meanwhile, an individual with a Compulsive Personality would be eating their perfect ice cream, while silently judging the sloppy, melting waffle cones around them. They might flip a biscuit if someone’s drip hits the floor they just spent 5 hours cleaning for no compensation.

Ep 04: Personality Disorders as Ice Cream Flavors

Tue, 18 Jun 2024 02:00:01 +0000

In this episode of the Personality Couch, we discuss the different types of personality disorders and compare them to flavors of ice cream. We explore the personality disorders that are always in season and the ones that come and go depending on cultural and social factors. We will highlight the ingredients that make up each disorder and how they manifest in individuals. Personality disorders are presented in three clusters: Cluster A (odd or eccentric), Cluster B (dramatic or erratic), and Cluster C (anxious or fearful) with descriptions and examples of each disorder within these clusters. If you want to jump to a specific cluster, please use one of the timestamps/chapters below.

Personality Disorders as Ice Cream Flavors

Tue, 18 Jun 2024 02:00:00 +0000

Personality disorders can be better understood using ice cream as an analogy. However, I must acknowledge my own bias, as I LOVE both ice cream and personality disorders! Whether you love or loathe either, your understanding of personality disorders will increase in a “flavorable” ;) manner after reading below!

Photo by Lama Roscu on Unsplash

So let’s dive into what the personality disorders are and if they were ice cream, what would they be? First, there are three categories, or “clusters,” in which personality disorders are organized. Cluster A contains three personality disorders characterized by “odd or eccentric” patterns (Paranoid, Schizoid, Schizotypal). Cluster B contains four personality disorders characterized by “dramatic, emotional, or erratic” patterns (Antisocial, Borderline, Histrionic, Narcissistic). Cluster C contains three personality disorders characterized by “anxious or fearful” patterns (Avoidant, Dependent, Obsessive-Compulsive).

CLUSTER A: Odd or eccentric patterns of personality

Paranoid Personality Disorder

DSM-5-TR Description: “Distrust and suspiciousness such that others’ motives are interpreted as malevolent.”

Photo by Sina Katirachi on Unsplash

These patients are rarely seen in outpatient treatment, as there is an extremely high level of distrust and suspiciousness of others. They often have a pretty rigid perspective that everyone/the world is out to get them. They tend to believe (without evidence) that others wish them harm, are not loyal, will use information against them, and will attack them. Thus, they are unwilling to be vulnerable, quickly reacting with defensive anger and lashing out at others.

If they were an ice cream, they would be Catching Fire ice cream (Vanilla ice cream colored orange with orange juice, mango, a strawberry swirl, and a REAL scorpion on top). A lovely flavor, until you get to the scorpion. When fearful, the scorpion will defend itself by stinging, making it difficult to trust this ice cream type!

Schizotypal Personality Disorder

DSM-5-TR Description: “Acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.”

Photo by Shayna Douglas on Unsplash

These patients are less commonly seen in outpatient treatment due to lower needs for socialization and possible paranoia. They often present with inappropriate or constricted emotional expression, and they can have odd beliefs, thinking, speech, behavior, and appearance. Schizo- means “split,” and these individuals straddle the line between reality and fantasy. They may experience ideas of reference (falsely believing that random/irrelevant occurrences in the world directly relate to oneself), and/or magical thinking (belief that specific words, thoughts, emotions, or rituals can influence the world around them). They can also be socially anxious and suspicious of others, resulting in fewer relationships.

If they were an ice cream, they would be Orange Creamsicle. The dichotomy of vanilla and orange mirrors how they straddle the line between reality and unreality. They’re gentle souls that have distortions in thinking and reality, leading to eccentricity and oddness.

Schizoid Personality Disorder

DSM-5-TR Description: “Detachment from social relationships and a restricted range of emotional expression.”

Photo by Jason Leung on Unsplash

These patients are less commonly seen in outpatient treatment due to detachment from social needs. They are relationally disconnected and can be emotionally cold, with little or no emotional expression. They tend to be indifferent to close relationships, praise or criticism, and pleasurable activities. Here the Schizo- “split” is between the individual and their needs, as well as the individual and the world.

If they were an ice cream, they would be Matcha Green Tea. They tend to withdraw to their own minds, disconnected from their own bodies and the social world. They’re a nonthreatening, subtle, yet odd flavor with no dramatics. They might be hard to find and equally just as likely to go unnoticed🐢.

CLUSTER B: Dramatic, emotional, or erratic patterns of personality.

Antisocial Personality Disorder

DSM-5-TR Description: “Disregard for, and violation of, the rights of others, criminality, impulsivity, and a failure to learn from experience.”

Photo by Toa Heftiba on Unsplash

Note: "Antisocial" (against social norms) is different from "Asocial" (detached from social interaction)

These patients are rarely seen in outpatient treatment (unless court-ordered) due to the inherent power imbalance between the client and therapist. Also, they likely think they don’t need help since they believe societal structures are ridiculous. They reject and move against social norms, including norms that are moral (e.g. lying, cheating, stealing), with no remorse. They can be impulsive, aggressive, irresponsible, and reckless. Interestingly, this diagnosis requires evidence of Conduct Disorder with onset before age 15.

If they were an ice cream, they would be Activated Charcoal, or a sorbet. They’re dark and violate boundaries, defying social norms/contracts. They reject being ice cream to begin with (so they become sorbet), or if they do accept being an ice cream flavor, it’s going to be dark, sinister, and black like charcoal.

Borderline Personality Disorder

DSM-5-TR Description: “Instability in interpersonal relationships, self-image, and affects, and marked impulsivity.”

Photo by Kyle Hinkson on Unsplash

These patients are very commonly seen in outpatient treatment because they tend to be intensely in touch with their pain and are motivated for help. Often embodying a “push-pull" dynamic, their relationships, self-image, and emotions are unstable. Struggling with impulsivity, they often feel empty, which can present as defensive anger, either toward others or themselves. They can experience paranoid ideation or severe dissociative symptoms when really stressed, but these symptoms are not long-lasting.

If they were an ice cream, they would be base flavors: Chocolate or Vanilla. They’re always hurting, so they’ll often show up to therapy. They can have different ingredients, and they’re not all the same, looking (and tasting) vastly different.

Histrionic Personality Disorder

DSM-5-TR Description: “Excessive emotionality and attention seeking.”

Photo by Courtney Cook on Unsplash

These patients are commonly seen in outpatient treatment because of the attention a therapist can provide to their excessive emotionality. Their emotions change quickly and are shallow, dramatic, theatrical, and exaggerated. They want to be the center of attention and are uncomfortable if they are not. Often using their appearance to elicit attention toward themselves, they can act in seductive and provocative manners, with speech that can be vague but excessively impressionistic. They tend to be suggestible and feel like their relationships are closer than they actually are.

If they were an ice cream, they would be Cotton Candy with Pop Rocks. They are colorful, explosive, dramatic, and attention grabbing. Having a superficial facade that is exaggerated and theatrical, if you look deeper, there is no substance behind it.

Narcissistic Personality Disorder

DSM-5-TR Description: “Grandiosity, need for admiration, and lack of empathy.”

Photo by Moon Bhuyan on Unsplash

These patients are rarely seen in outpatient treatment because they believe it is others who are the problem, not themselves. They desire to be recognized as superior, want excessive admiration, and are preoccupied with success, power, beauty, brilliance, etc. They believe they are special and thus have a sense of entitlement. They take advantage of others, lack empathy, tend to be arrogant, and are often envious of others.

If they were an ice cream, they would be Peppermint with Ghost Pepper pieces. A lovely, charming peppermint flavor at first bite, with grandiose ghost pepper tidbits that will burn and exploit you, unempathetically and unashamedly. You might even get a few charming and refreshing peppermint bites before realizing the pain of the ghost pepper that is about to come.

CLUSTER C: Anxious or fearful patterns of personality.

Avoidant Personality Disorder

DSM-5-TR Description: “Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.”

Image by Freepik

These patients are commonly seen in outpatient treatment, often with relational concerns (i.e. social anxiety), and especially when they have to be close with others. They view themselves as inferior, socially inept, and unappealing. They are very concerned with possible rejection or criticism in social situations because they feel inadequate. Because of this, they might avoid, limit themselves, or engage reluctantly in situations that could lead to criticism/rejection.

If they were an ice cream, they would be Cookies and Cream ice cream. They are the distance side of the borderline push-pull dynamic. They run from relationships to avoid the pain of being rejected. They have that vanilla base, but it’s a different kind of cookie. They are so fearful that they would rather not be close to others so they won’t get hurt.

Dependent Personality Disorder

DSM-5-TR Description: “Submissive and clinging behavior related to an excessive need to be taken care of.”

Photo by Filip Baotić on Unsplash

These patients are commonly seen in outpatient treatment, often with relational concerns, especially if they feel alone. They are indecisive, having low self-confidence and needing excessive reassurance. Fearful of self-sufficiency, they go to extreme means to get nurturance and support. Dependent individuals will avoid disagreeing with others due to fear that support or approval will be withdrawn. They have difficulty being alone and seek a new relationship as soon as one is terminated.

If they were an ice cream, they would be Cookie Dough. They are the “pull me closer” side of the borderline push-pull dynamic. The need for relationship, reassurance, and rescuing reminds me of a stereotypical movie breakup where the leading female intensely cries into the cookie dough ice cream in pain (a very acceptable coping mechanism, if I do say so myself)! They need to be in a relationship where the other person takes care of them.

Obsessive-compulsive Personality Disorder

DSM-5-TR Description: “Preoccupation with orderliness, perfectionism, and control.”

Photo by Keriliwi on Unsplash

These patients are rarely seen in outpatient treatment because they don’t have time and are always “put together.” Therapy could be a threat to their control - a control that tightly contains their emotions. They need so much structure and perfectionism that it interferes with task completion. They are workaholics and reject leisure, as they are rigid, overconscientious, and stubborn. Having difficulty delegating because of their controlling nature, they also have problems discarding resources like money.

If they were an ice cream, they would be Coffee. They are the caffeinated energy that is required to pursue perfection and exactness. Their rigidity is so abundant that it spills out and splashes onto others as well. Excess energy is used to control their environment, values, ethics, and morality, so they need caffeinated ice cream to keep going (which is likely consumed after two to nine cups of actual coffee that day)☕.

Ep 03: How to Spot a Personality Disorder

Mon, 03 Jun 2024 08:02:00 +0000

In this episode of the Personality Couch Podcast, we discuss how to spot a personality disorder. We explore the definition of a personality disorder according to the DSM, which includes enduring patterns of behavior that deviate from cultural expectations and cause distress or impairment. We also introduce the concept of the drama triangle, where individuals can take on different roles such as rescuer, perpetrator, or victim. We discuss how to spot personality disorders through observations of thinking patterns, moods, relationships, and impulsivity. We emphasize the importance of trusting your intuition and paying attention to your body’s reactions when interacting with someone who may have a personality disorder.

What Are Personality Disorders (And How You Can Spot Them!)

Mon, 03 Jun 2024 08:02:00 +0000

Personality is everywhere. One of my favorite sayings is, “People are really people-ly.” The people-y-ness of humans is always there, and unfortunately, some of it is at the disorder level. Personality disorders are not going away. Some would even argue that as we become more inner-connected in our world, we’re only going to see more of them.

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You can find the definition of a personality disorder here, but how do these problems actually show up?

It shows up in thought patterns and thinking, as we all have our own perception of ourself, others, events, and the world around us.
It shows up in emotional patterns and moods, including intensity, moodiness, and appropriateness of emotional responses.
It shows up in interpersonal patterns, as there are usually constant ruptures in relationships or in things that require socialization - like work or school.
It shows up in impulsivity dynamics, or essentially acting without thinking. Typically, we don’t consciously think disordered thoughts, decide to be inappropriately emotional, or lose people for the fun of it. It’s sub/unconscious dynamics that are developed. Thus, there is a tendency to engage in a disordered behavior or dynamic in a way that is impulsive.

That’s the textbook answer… But what about intuition?

When interacting with a disordered personality, you can feel it in your gut first. Your body knows before your brain registers it. Something just feels off about this person. You might feel uncomfortable or feel like something isn’t right. You might feel unsafe - physically, emotionally, and/or mentally. Maybe the person’s body language was off compared to what they were saying.

We call this feeling “pulled”. In psychological training, it is sometimes called the “Axis II hook” (because personality disorders were previously classified on the second axis when diagnosing… A story for another time). You feel this pull in your gut to respond in a way that maybe defies social norms or goes against your own normal reactions. Even after your interaction with the person, you still might feel off-centered or simply yucky. That’s because disordered personality dynamics tend to “leak” past normal boundaries like an oil spill. It affects your natural psychological defenses and can leak into your own life, your sleep, your thoughts, etc.

You can feel disordered personality dynamics in your mind. For example, after conversations with a person who has a disordered personality, you leave feeling confused… or unsteady yourself… or even questioning reality (including gaslighting). Maybe you find yourself taking notes after your conversations with this person or recording conversations, as they seem to be operating in a different dimension. This is where personality disorders can almost seem delusional, as they operate in a different version of reality. Social cues are detected differently and with different motives.

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And of course, You can feel disordered personality dynamics in your emotions. You might feel like your emotions are out of proportion or wrong or simply out of place. You might feel more or less emotions than you normally would. You may be in an emotional state well after your interaction with the person has passed. The emotions stick to you outside of the person and your interactions with them. Most of the time this is because the person is either projecting their own stuff onto you or attempting to transfer their own pain onto you.

Typically, this doesn’t happen with every interaction, though it might with some of the more severe disorders. There’s still severity differences within the disordered level, like a continuum. But that makes it more confusing, right? Sometimes it’s normal, sometimes it’s not. Sometimes social situations are interpreted like the rest of the social herd, but other times it’s way out in left field…. And you get pulled. Essentially, social norms and social contracts are broken somewhat regularly. There’s a pattern, and it’s not just a one off.

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Where does the hook come from?

We keep talking about being pulled, but why? Where does the hook come from? It comes from a disordered personality’s unstable sense of self. They have no self, and thus have an “empty spot” within them (a void, if you will), so they need something from you. They need to borrow something from you or lean on you because their sense of self is unstable.

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For example, an inebriated person can’t can’t walk in a straight line, just like how individuals with personality disorders have a hard time navigating the social world… so they use others to steady themselves with this “hook.” It’s typically unconscious and is a reflex to survive with the tools they have. It’s not necessarily malicious or on purpose, though sometimes it can be in some disorders. I personally think that individuals with personality disorders fill their empty spot by creating the same hurt that shaped them.

Ep 02: What is Personality

Mon, 03 Jun 2024 08:01:00 +0000

In this episode of the Personality Couch Podcast, we discuss the concept of personality, its classifications, and its impact on behavior and relationships. We explore various historical classifications of personality, including the four temperaments from ancient Greece and the Enneagram. We also touch on modern classifications such as the Myers-Briggs Type Indicator and the Big Five personality traits. We emphasize the importance of understanding personality disorders and the need for early intervention and treatment. Overall, the episode provides a comprehensive overview of the topic of personality.

What is Personality?

Mon, 03 Jun 2024 08:01:00 +0000

Why Did Personality Become a Thing?

At the foundation, we want to understand the world, and our brains are wired to make categories. There’s so many facets of personality that in order to understand, we need to group things together into similarities and differences. We actually have an extensive history of sorting and categorizing people (e.g. physical traits, culture, socioeconomic status, Harry Potter houses).

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Plus, personality shows up everywhere. Pets interact with people, other animals, and their environment differently. Babies are a “raw form” of personality that continues to develop but also maintains some traits. You can have two siblings raised in the same household who are night and day! Personality is expressed through interaction with the environment → which is why it’s important!

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What is Personality Anyway?

The word “personality” stems from the Latin word persona, which refers to a theatrical mask worn by performers to play roles or disguise their identities. Some theorists would say personality is a reaction – it’s a way to conceal what’s going on deep deep inside of us. Others would say it reveals what’s going on deep inside of us. We say it’s possible to be both! Britannica’s definition is complex, but let’s just say that personality is “a characteristic way of thinking, feeling, and behaving,” and personality distinguishes one person from another.

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The American Psychological Association (APA), which is our governing body for psychological practice, has a long definition you can find here. In sum, personality is the intangible and concrete pieces of YOU, which means it’s hard to study and classify…but not impossible, which is why we’re here to help guide you in your journey!

Classification of Personality

Personality is complicated! There’s no one theory that is “right,” but each theory is another way to look at the numerous facets! What are some ways we’ve classified personality over the years? Let’s start with 460-370 BC in Greece when personality was classified by your poop, by your snot, and by your blood. Seriously!

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Hippocrates coined these terms for Four Temperaments: Sanguine (Blood), Choleric (Yellow Bile), Phlegmatic (Phlegm), and Melancholy (Black Bile).
Then we have the Enneagram from who knows when? It’s been around a long time, but the beginnings of it are still in question. It contains 9 types of personality and is very dynamic (meaning it shows personality movement!), opposed to categorical.
Psychoanalysis/Psychodynamic conceptualizations of personality started early. In the early 1900s, Freud (1856-1939) became the big player, introducing aggression and libido influences on personality.
The Myers-Briggs Type Indicator (1944) was based on Carl Jung’s (1921-1971) personality work.
In 1949, Cattell developed the 16 personalities, which led to the original Big Five in 1968, then the current Big Five (OCEAN model of personality) from the 1980s onward.
In the 1950s, cardiologists (Meyer Friedman and Ray Rosenman) started to organize personality characteristics based on reactions to stress, identifying Type A, B, C, and D.
When the big book used to make mental health diagnoses (Diagnostic and Statistical Manual 1 or DSM-1) was published in 1952, there was actually no good classification of personality at the disorder level. This came almost three decades later in 1980 when the DSM-III was published with research to validate disorder level functioning. We are now on the DSM-5-TR and have come a long way! However, there’s still SO MUCH to learn!

What is Disorder Level Personality?

According to the DSM-5-TR, disordered personality “is an enduring [lifetime] pattern of inner experience and behavior that deviates markedly [differs] from the expectations of the individual’s culture, is pervasive [occurs in most settings] and inflexible [rigid], has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment [even if it’s only pointed out by others!].” If something is out of whack with personality, others notice. Signs that personality is problematic include constant ruptures in relationships or in things that require socialization, like work or school. This is a sign you or a loved one need to see a professional.

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Want more info? Check out How to Spot a Personality Disorder!

Ep 01: Introduction to the Hosts: Our Personality Journeys

Mon, 03 Jun 2024 02:00:01 +0000

In this episode, we (Doc Bok and Doc Fish) introduce ourselves and share our personality journeys and career paths! Doc Bok talks about her windy journey to personality, which includes deciding between her doctorate or a career in the FBI. Doc Fish shares about her linear journey to personality and psychology starting in childhood and her intrigue into psychodynamic work with clients. We both discuss why personality is so important, as well as different modalities and approaches to understanding personality, all the while emphasizing the complexity and nuances involved. We express our curiosity and desire to understand people, sharing a mutual passion for the detective work needed to solve the most challenging personality puzzles!

Welcome to the Personality Couch!

Sat, 23 Mar 2024 00:00:00 +0000

We all encounter personality conflict on a regular basis, whether we know it or not. From funky, can’t-quite-put-my-finger-on-it dynamics with that one friend or family member, to the big blowup drama at work with the last person you’d expect, it all comes down to personality.

Join licensed clinical psychologist, Doc Bok and colleagues as they unpack the most complex topics like personality disorders and psychopathic behavior, while also making room for lighthearted discussions about personality typologies and humorous anecdotes from private practice. Whether you’re fascinated by personality darkness, a concerned friend or loved one, an “armchair psychologist,” or a licensed professional convinced there is something more going on with patients…. This channel is for you.