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Mental Disorders

Defining Features of Personality Disorders: Problematic Emotional Response Patterns

Simone Hoermann, Ph.D., Corinne E. Zupanick, Psy.D. & Mark Dombeck, Ph.D.

People with personality disorders exhibit characteristic, emotional response patterns that can become problematic.  Generally, each of the personality disorders has an emotional response pattern that is associated with that particular disorder. This inflexible pattern of emotional response often creates difficulty.  Some personality disorders are characterized by emotional sensitivity and a tendency to experience feelings with great intensity.  Other personality disorders are characterized by little or no emotional response, regardless of the circumstance or situation.  Yet another set of disorders are characterized by bouncing back and forth between these two extremes: from being overwhelmed with intense emotions one moment, to feeling numb and disconnected in the next.

emoticonsSome theorists understand this aspect of personality disorders as a problem of emotional regulation; some disorders are characterized by a tendency to under-regulate emotions, whereas others tend to over-regulate emotions.  This differs from a healthy personality where we expect a full range of emotional intensity from controlled to fully expressive.  This range is dictated by the situation and circumstance.  Of course, people with healthy personalities will occasionally get overwhelmed with emotions, or can feel emotionally detached at times.  Similar to the distorted thinking patterns we discussed earlier, the problem for people with personality disorders is the extreme degree and persistence of their dys-regulated affect.

In addition, people with healthy personalities tend to understand when it is beneficial to express a particular emotion, and when it is best to restrict its expression.  In other words, people with healthy personalities have learned that there are times when it is wise and appropriate to fully express a particular emotion. At other times it is best to regulate or restrict its expression, or to dampen down its intensity.  Having decided just how much emotion is appropriate to display, they then display only the appropriate amount, knowing just how to do that.  As we have emphasized previously, a key feature of healthy personalities is flexibility. Healthy personalities have a flexible range of affective responses that properly consider the time, place, and circumstance.

Unfortunately, persons with personality disorders are not nearly as flexible. Depending upon the type of personality disorder, affective (emotional) features can range from being very constricted, indifferent, cold, and experiencing little pleasure in life; to rapidly changing and wildly fluctuating emotions, often expressed with great intensity and dramatic flair. In some personality disorders this lack of flexibility surrounding emotional expression leads to problems with chronic anger and irritability, problems with extreme anxiety, or a complete lack of empathy.

Examples of personality disorders with problematic emotional response patterns 

Just as we did before when we considered disordered thinking patterns, let's look at some examples of specific personality disorders to illustrate these problematic emotional response patterns, and the types of interpersonal problems that are created a result.

People with Schizoid Personality Disorder are at the over-regulated end of the affective spectrum and appear emotionally constricted and indifferent. They tend to experience little or no pleasure in things, seem indifferent to praise or criticism, and come across as detached, cold, and unexpressive. To other people, they seem unfeeling, unresponsive, and insensitive and are thus unlikely candidates for friendships of any sort. On the other side of the affective spectrum is the Histrionic Personality Disorder, which represents emotional under-regulation.  This disorder is characterized by an extremely reactive emotional pattern that shifts very rapidly. These people tend to be rather dramatic in their emotional expression to such an extent they seem to be disingenuous, shallow, and insincere.  Other people will often react to their intense emotional expression with discomfort, and regard the rapidly shifting emotions with a sense of disbelief or distrust. 

For persons with Avoidant Personality Disorders, the anxiety they experience in social situations and their fear of being inadequate, rejected, and ridiculed, dominates their emotional life and interferes with their ability to function. Their high level of anxiety causes them to avoid social situations such as parties and other social gatherings. Typically, people with Avoidant Personality Disorder have only a small number of close friends. Similarly, for people with Dependent Personality Disorder, anxiety dominates their affective experience. However, in contrast to those with Avoidant Personality Disorder who prefer to avoid relationships, people with a Dependent Personality Disorder are preoccupied with fears of being alone, fears of separation and abandonment, and fears of not being taken care of by others. Their anxiety over the possibility of losing important caregivers and their fear of being unable to take care of themselves can make it very difficult for them to stand up for themselves. Consequently, they may tolerate mistreatment, and avoid conflict at the expense of their dignity and self-respect.

The Borderline Personality Disorder provides an example of the affective pattern of experiencing both emotional extremes; from highly intense and dys-regulated emotions, to the extreme opposite-- feelings of numbness and detachment. Persons with Borderline Personality Disorder tend to be highly sensitive and react with great emotional intensity. They have powerful feelings in the context of interpersonal relationships particularly when difficulties and conflict cause them to feel intensely anxious, angry, or down. During interpersonal conflicts they become easily overwhelmed with the intensity of their emotions, and may have a hard time calming down once they are upset. At other times, people with Borderline Personality Disorder can rapidly shift to the polar opposite and suddenly feel completely disconnected, numb, empty, and detached. Many people with Borderline Personality Disorder end up injuring or harming themselves in reaction to this emptiness and the accompanying feelings of numbness. Other people tend to react with fear or anger to their rapidly shifting emotional states and their self-injurious behavior. This only serves to escalate interpersonal conflict. Therefore, interpersonal relationship difficulties and conflicts are a common consequence of the intense, rapidly fluctuating emotions associated with this disorder.

For most of us, an emotion is connected to an urge to "do something". For instance, when we get angry, we may have an urge to verbally or even physically attack the other person with whom we feel angry. When we feel anxious, we may have an impulse to run away or avoid the situation that is frightening us. Healthy people do not typically act upon these impulses if the action associated with the impulse is not situationally appropriate. However, for people with Borderline Personality Disorder, emotions may become so intense that it becomes difficult for them to avoid acting on these impulsive urges; regardless of the whether it is wise or healthy to do so. For example, a diagnostic criterion for Borderline Personality Disorder is outbursts of intense anger that often result in yelling, throwing things, or even hitting other people. It is not simply the intensity of the emotion that causes these dangerous outbursts. Most of us at one time or another have experienced some form of intense anger, or even rage. Rather, problems occur when intense emotion is coupled with a lack of impulse control.  As we will see in the next section, this issue of self-control is another defining feature of personality disorders.