122 Anxiety, Somat%rm, and Dissociative Disorders

forces in the person's social circle that prompted particular behavior. Thus,
parents who are suggestible and reward the child for showing off predis-
pose the child toward hysterical symptoms. Those who parents made a big
6
fuss over health-related matters were being guided toward hypochondria-
sis at the same time, and so on. In both the behaviorist and psychoanalytic
theories of neurotic disorders, there is a crucial role played by social fac-
tors. The major difference between the theories is the significance each ac-
Personality 'Disorders
cords to hidden, unconscious origins since these are only vital issues in psy-
choanalytic theory.

AN OVERVIEW

DSM-llI defines personality traits as " ... enduring patterns of perceiving,

relating to, and thinking about the environment and oneself ... exhibited
in a wide range of important social and personal contexts. It is only when
personality traits are inflexible and maladaptive and cause either significant
impairment in social or occupational functioning or subjective distress that
they constitute personality disorders.'" Personality disorders are a wide-
spread category of mental illness. They seldom result in hospitalization for
two reasons; first, relatively speaking, they are not as disabling as most of
the disorders discussed previously; second, one of the most common disor-
ders, the antisocial personality disorder, is frequently found among criminals,
people who are not likely to seek help.
The personality disorders are grouped into three "clusters" with
shared characteristics. The first cluster includes paranoid, schizoid, and
schizotypal personality disorders. People with these disorders often appear
"odd" or eccentric. The second cluster includes histrionic, narcissistic, antiso-
cial, and borderline personality disorders. Individuals with these disorders of-
ten appear overly dramatic, emotional, or erratic. The third cluster in-

'American Psychiatric Association, Diagnostir and S/fltil/iml Mrl/llial of Mental Di,ordl't:I

(Third Edition) (Washington, D. c.: American Psychiatric Association, 1980), p. 305.

123
124 Personality Disorders Personality Disorders 125

cludes avoidant, dependent, compulsive, and passive-aggressive personality

hostile and aggressive feelings appropriately; they cannot express such
disorders in which people usually appear fearful or anxious. There is also a feelings when they are justified, but may react with anger to trivial events.
residual category for atypical, mixed, or other personality disorders. They view love in purely intellectual ways in an effort to avoid sexuality. If
Since there is not enough space here to delineate all of these disor-
they ever do marry, they consider sex to be part of a contractual
tion.3 obliga-
ders, only the well-researched disorders are detailed in this chapter. For
the most part, emphasis is placed on symptoms rather than etiology. This is Some distinguish between two schizoid types: the oversensitive and
because many of these conditions are milder versions of some of the func- the dull.' Oversensitives (more commonly found among females), feel mis-
tional psychoses and neurotic disorders discussed in earlier chapters. Gen- understood by others who look upon them as odd or snobbish. Conse-
erally speaking, what is known about the causes of those more severe conditions may quently, they are often teased and criticized. This schizoid eases the hurt of
also be applied to their personality disorder counterparts. Can people with personality
social ostracism by taking refuge in autistic thoughts which are typically
disorders "graduate" to the more severe forms of abnormal behavior? This seems filled with fantasies of being powerful and vengeful. Dull schizoids (more
likely if a person pxveriences enough stress. commonly found among males), are unsociable, colorless, and indifferent.
Much of this chapter is devoted to understanding the symptoms and They are often jealous of those who appear happier with life and are com-
causes of the antisocial personality disorder. Not only is this condition well
monly referred to as "lone wolves." Their usual reaction to misery is to di-
researched," but it accounts for a number of acts by "conscienceless" people rect their energies to nonhuman objects as in the case of the "bookworm."
who steal, rape, or murder without remorse. As such, it blatantly signifies
Schizoids of both types experience subjective discomfort because they
the gross impact of mental illness on society. feel dissatisfied with life and consider it to be meaningless. The schizoid
should not be confused with the "introvert." Introverts are shy and with-
PARANOID PERSONALITY DISORDER
drawn but they difler from schizoids in that they can form relationships
with others, express anger appropriately,
with life. and are usually more satisfied

The paranoid personality disorder is the milder counterpart to the para- The factors which produce the schizoid personality approximate the
noid disorders discussed in chapter 4. These people are chronically jealous, biogenic and environmental forces that can cause schizophrenia. This is
suspicious, pessimistic, and get easily insulted by others even when no harm supported by the fact that schizoids come from the same biogenic and psy-
is intended. They complain of being discriminated against, by teachers at chosocial backgrounds as schizophrenics." Since schizoids and schizophren-
school, by peers in social activities, and by employers at work. If someone ics are often members of the same family, it is difficult to determine
else receives an award, paranoids often protest that favoritism was in- whether these disorders are caused by genetic factors, environmental fac-
volved. They are also likely to accuse friends of using them and spouses of tors, 01- both. It is interesting to note that, in monozygotic twins who are
being unfaithful. discordant for schizophrenia (one is schizophrenic and the other is not),
Paranoids feel inferior, but they try to counteract this feeling by per- the nonschizophrenic twin is often a schizoid personality. In one such
forming difficult tasks. Because they lack the Aexibililty to make superior study, the schizophrenics' identical twins were schizoid in 43.7 percent of
accomplishments, they criticize the efforts of others, an overuse of the the cases.6 Given the degree of difference in the psychopathological state of
mechanism of projection. There are many reports that they are often at- these identical twins, it is logical to conclude that they were not exposed to
tracted to joining political groups, especially groups organized against equivalent child-rearing experiences. For instance, one twin may have been
something. However, since they become so overtly suspicious of other exposed to double-bind messages while the other was not subjected to such
stress.
members of the group, the feelings usually become mutual. Consequently,
they rarely attain leadership positions in socially acceptable organizations, What appears to separate schizoids from schizophrenics is social acci-
b~t may be overrepresented among leaders of mystical or esoteric reli- dent since schizoids are personalities who happened to avoid factors which
gIOns. would have caused a full-blown schizophrenic experience. Cadoret appro-
priately refers to schizoids as a "forme fruste" of schizophrenia, a rough
form which can be "polished" to psychosis.7 In fact, the schizoid will
SCHIZOID PERSONALITY DISORDER
"Alh'ed M. Freedman, Harold 1. Kaplan, and Benjamin J
Sadock, Modem Synopsi.1 of
A central symptom of this disorder is an inability to form close relation- ComprehelL,ive Textbooll of Psychiatry (Baltimore: Williams and Wilkins Co., 1985).
ships with others. These people are shy, withdrawn, and often eccentric. As 'Lawrence C. Kolb, Model'll Clinical Psydtia/ry (Philadelphia: W. B. Saunders Co., 1982).
children they were docile and dependent. They have diffICulty expressing -'Remi.J. Cadoret, "Toward a definition of the schizoid slate: evidence fr91l1 studies of
twins and their f~lmilies", British journal of Psychiatry, 122 (1973), pp. 679-685.
"Many studies use the term "personality disorder" interchan!{eably with the antisocial
"Ibid., p. 680.
type. 7Remi .I. Cadoret, "Toward a definition of the schizoid state," p. 679.
126 Personality Disorders Personality Disorders 127

ANTISOCIAL PERSONALITY DISORDER

decompensate into schizophrenia under conditions of overwhelming
stress."
Symptoms

SCHIZOTYPAL PERSONALITY DISORDER Perhaps no other disorder is more clearly related to society than the
antisocial personality. This type of person suffers from a weak or absent
superego, the intrapsychic representative of society. DSM-1I1 reserves the
This is a new category reserved for people who have various oddities of
term for individuals who are basically unsocialized and whose behavior re-
thought, perception, speech, and behavior which are similar to, but not as peatedly conflicts with society's expectations. These conflicts ensue because
severe as, the abnormalities of schizophrenics. Since they share many of the
the demands of the person's instincts have not been adjusted to the de-
symptoms of schizophrenics on a milder level (inappropriate thinking, so- mands of society. Because of the blatant sociological nature of this disorder
cial isolation, recurrent illusions, and the like), it appears that this personal-
and the fact that it is the most well-researched of all the personality disor-
ity type, like the schizoid, many eventually decompensate into schizophre ders, a considerable part of this chapter is devoted to it.
ma.
The central symptom is a defect in the conscience, technically known
as superego laClluae. This allows the person to pursue a lifestyle which regu-
HISTRIONIC PERSONALITY DISORDER larly opposes the laws and mores of society. Typically, immoral behavior is
exhibited in many aspects of life although, as children, antisocial personali-
Superficially, the histrionic personality exhibits an overly optimistic view to- ties may have only been immoral in particular areas. They may have been
ward life. This personality, found mainly among females, is also highly ex- thieves, but not truants, or they may have set fires but behaved normatively
citable, over-reactive and attention-seeking. To gain the attention of otherwise. At that age, the superego appears to be "punched out" with re-
others, they may self-dramatize, act seductively, or lie. Frequently, contra- gard to certain norms. Because these people lack a well-developed con-
dictory traits such as friendliness and hostility, prudishness and promis- science, they can freely pursue antisocial activities without the pain of guilt.
cuity, coexist. These people appear to be unaware of the implications of Psychiatrists typically report that antisocial individuals act as if they are in
their contradictory behaviors to others. For instance, a histrionic female different to the social impact of their behavior. The truth is they are not
acting; they really are indifferent.
will dress and talk suggestively, go home alone with a man, and act shocked
when he makes sexual advances. What is noteworthy about histrionics is Since the superego defect causes antisocials to be callous to societal
that they behave seductively while they are actually frigid. norms, they live by the pleasure principle; their primary concern is imme-
Other traits frequently found among these people include a craving diate gratifIcation of instinctual impulses. Freud recognized this personal-
for activity and excitement, and irrational, angry outbursts or tantrums. ity type and referred to it as the "erotic type" because such people seek only
pleasure regardless of the welfare of others.
Some are extremely vain and demanding, while others are prone to manip-
ulative suicidal threats or attempts. In a way, these are people who have Since antisocial individuals persistently violate the laws and mores of
society, it is other people who suffer, rather than the violators themselves.
never grown up and, as a consequence, they maintain a need to be the cen-
ter of attention. The hlCt that they have no remorse for the harm they do others exacer-
bates the problem further. In fact, they have an inner conviction that they
are special people who are immune to society's rules and, in a sense, they
NARCISSISTIC PERSONALITY DISORDER are, for they have no internalized element of society. These attitudes, com-
bined with a superego defect and an extreme sense of narcissism, render
This is a new category in DSM-Ill which essentially refers to people who antisocial personalities dangerous people. When they are frustrated, they
have a grandiose sense of self-importance and an exhibitionistic need for can spontaneously commit a number of offenses including robbery and
constant attention and admiration. Like the histrionic personality, the nar- rape. In fact, these are people who could become profit murders or "hit
cissistic type may be extremely self-centered. They overestimate their abili- men" because they feel no guilt in committing such crimes. Rarely do they
ties and achievements and have fantasies typically involving themes such as take their own life through suicide simply because they are self-loving.
power, wealth, or brilliance. They may expect special favors from others Antisocial individuals do not experience any subjective discomfort
but will not reciprocate. They are exploitive people who take advantage of from their condition as some neurotics do. Their only anguish stems from
others with no regard for their rights. As such, they are very similar to anti- the fear of getting caught and being punished for moral or legal violations.
social personalities discussed in the next section. If they are punished, they are likely to repeat their behavior. They do not
learn from experience since punishment cannot create a conscience. When
"Not"man Cameron, P"f.IO/lILlity /)"111'/0/11//1'111 alld P.\yrho/Hltlw/ogy: A Dynamic APlJ1"oarh they do get into trouble, they usually project all blame on to others.
(Boston: Houghton Mifflin Company, 196:~), p. 64H. Un reliability and chronic lying are also common features.
128 Personality Disorders
Personality Disorders 129

If the antisocial person has any goals, they are immediate and di- Diagnostic Problems
rected toward self-aggrandizement, the acquisition of money, and the use
of others for pleasure. Using others is a particular skill of antisocial people This psychopathology has had a unique history in psychiatry. The an-
since they are often gifted, intelligent individuals with superficial charm." tisocial personality was originally called moml illsanity by Prichard in 1835.
These skills, along with an attractive physical appearance, make it easy for The label was later changed to avoid a moral issue which is foreign to mod-
them to carry out their plot adeptly. If antisocials are questioned about ern psychiatry. In the latter part of the nineteenth century, the disorder
moral and legal principles, they can verbalize all the correct rules but they was called constitutional psychopathic in{frior, a renection of the somatogenic
do not really understand them or believe them in the way that others do. orientation of the time. Other terms that have been used are anethopathy,
Checkley calls this verbal facade the "mask of sanity.""' See Box 6: I on se- sf"rnantic d('mentia, and, more recently, p.sychopatltic and sociojJathic. They all
rial murders. refer to the personality disorder which is now classified as antisocial.
BOX 6:1 SERIAL MURDERS The label for this condition continually changes, in part, because
I there is confusion regarding the personalities which should be included
within the category. Some feel that so many different types of personalities
Recently, serial murders have reared their ugly head in the United States. can be considered antisocial that the term has become a diagnostic waste-
The phenomenon is an extreme example of how far conscienceless people basket. This is true to an extent since individuals with any of a number of
will go for pathological "kicks." This was painfully clear in the case of john disorders may engage in occasional antisocial behavior as occurs among
Wayne Gacy who sadistically murdered at least 33 young men and boys. Out- those with organic brain syndromes and schizophrenia. In these instances,
wardly, Gacy displayed a mask of sanity by dressing up as "Pogo the Clown" however, the antisocial behavior is only a consequence of a qualitatively dif-
while making the rounds of children's wards in hospitals and serving as chap- ferent condition. Other cases involving antisocial behavior and an addi.
lain in the Jaycees. Ted Bundy roamed the country, periodically killing as tional disorder are more difficult to unravel. For example, many antisocial
many as 33 women, all pretty, small, and dark-haired. To date, none has ap- individuals indulge in alcohol and narcotics. It is generally considered that
proached the macabre level of Henry Lee Lucas, who claims to have mur- the antisocial condition establishes a predisposition for drug abuse, but it is
dered 360 people in 36 states and three different countries. One leading ex- also
laws possible that chronic drug intake can generate a disregard for social
and customs.
pel-t on serial murder thinks there may be as many as a hundred such
murderers on the loose right now. A further example of a possible overlap between the antisocial diag-
Below are some quotes from Henry Lee Lucas. They will allow you to ap nosis and an other condition is the so-called gall.wr syndrollle. This is a
preciate the chilling make-up of a murderer without a conscience. Presently, psychotic-like state that occurs among hardened criminals. The central
there is some confusion as to how many people Lucas murdered since he may symptom is a dissociation from the social environment which typically oc.
ha~e lied about many killings for his own sick reasons. It is a fact that he has curs in a prisoner who has received a long term sentence. This is a tempo-
murdered, although the extent of his macabre acts remains a mystery. rary condition,
doomed. however, and usually Occurs when the antisocial feels
"I've got 360 people. I've got 36 Slates and three different countries. My
victims never knew what was gonna happen. I've had shootings, knifings, The most common difficulty in diagnosing this disorder involves the
strangulations, beatings, and I've participated in actual crucifixions ofthe hu- recognition that not all criminals are antisocial. Since the antisocial label is
mans. All across the country there's people just like me who's set out to de- applied from the viewpoint of the host culture, behavior which is acquired
stroy human life. I was death on women. I didn't--didn't feel they-they in a deviant subculture is sometimes confused with the antisocial condition.
need to exist. I hated them, and I wanted to destroy everyone I could find. Actually many members of deviant subcultures, particularly delinquents,
And I was doing a good job of it. I've tracked them from all over the United are conforming to the criminal norms of their subculture, just as conven-
States almost. just do it out of spite, you know. I want to torment 'em. Every tional people conform to the norms of mainstream society .'~ The activity of
time, they'd stop or go someplace. I'd be there. I'd follow them on the high- people who follow criminal pursuits but who are psychiatrically normal is
way. I'd go around them, play with 'em, back up and let them go by me. A called dyssocial behavior. This is a personality type that is different in impor-
woman alone ain't safe at alt."" tant ways from the antisocial type since the dyssocial person can form stable
relationships with others, although they may be members of a crime gang.
"David Abrahamsen, Thr P.\yrllOlogy oj Crill/I' (New York: Columbia University Press, In addition, the dyssocial person can defer pleasure, learn from experi-
1967), p. 135. High intelligence is only characteristic of the antisocial type of criminal. CrimI- ence, and feel guilt. None of these qualities exist within the antisocial per-
sonality.
nals with a conscience (such as those who rob out of perceived economic necessity) typically
have low intelligence.
"'H. Cleckley, The M{tJl, of Sanity, (SI. Louis, Mo.: Mosby, 1964).
"Excerpts taken from interview with I lenry Lee Lucas by Sylvia Chase, 20/20, Ameri-
can Broadcasting Companies, Inc., ./uly 5, 1984. Used with permission of American Broad- '"So Kirson Weinberg, "Social psychological aspects of aCling-out disorders and deviant
casting Companies, Jnc. pp. 150-158.
behavior," in Thr Sori%gy o/Mental Disorders, ed. S. Kirson Weinberg (Chicago: Aldine, 1967),
 Personality Disorders 131
130 Personality Disorders

Legal Issues
Other definitional issues regarding antisocial behavior involve the question
of criminal intent and mental illness. These concepts are incompatible in
the United States. If a bank has been robbed or a woman brutally raped,
legally there is no criminal act unless the perpetrator of the act is adjudged
mentally responsible. The decision is often a function of the particular so-
cial circumstances involved in the case. For example, if each of two women
is booked for her fourth shoplifting offense within a year's time, the court
decisions about the two cases may be quite different. If one woman was on
welfare with a large family, her shoplifting is seen as a rational act, and she
becomes criminally responsible. She will be pronounced guilty and be fined
or sentenced to jail. If the other woman is married to a rich physician, she is
not considered to be in need and therefore must have shoplifted because of
an "unreasonable need." The judge finds it impossible to perceive any
criminal intent. The woman is "clearly" ill and is committed to see a psychi-
atrist once a week as an outpatient.
Certain laws are designed to separate mentally ill people who commit
criminal acts from mentally competent people who do so. One such law is
the well-known M'Naghten rule. It provides that people may establish a de-
fense of insanity if they did not know that they were doing something
wrong in the eyes of society. A m<~or difficulty with this principle is that it
excludes those with antisocial personality disorders since they know that
others disapprove of their behavior. This is an inappropriate way to define
mental illness because many disturbed people are adjudged to have crimi-
nal responsibilities and are then punished with ajail term. The psychiatric
reality is that they often have a superego defect which requires psychiatric
help. However, since the M'Naghten rule is not sophisticated enough to de-
tect various types of disturbances, antisocial personalities are sent to prison
rather than a psychiatric facility where they might be helped. In prison
their condition usually deteriorates since they are placed with other crimi-
nals with whom they exchange tricks of the trade in "factories of crime."
The "right-wrong" concept of the M'Naghten rule is currently the
most prevalent ruling, even though more realistic decisions have been
made, such as the Durham test of sanity. According to this test, a person is
not criminally responsible if an unlawful act was the product of a mental
illness. Mental illness is determined by psychiatrists' evaluations conveyed
to the court. This approach has also proven difficult since psychiatrists of-
ten disagree regarding the mental status of the accused. Some psychiatrists
find very few accused criminals to be abnormal, while other psychiatrists
report severe abnormalities in almost all of the accused people they exam-
me.
The American Law Institute proposed its own guidelines on criminal
responsibility in an effort to specify the M'Naghten and Durham rulings.
According to these proposals, people are not criminally responsible for
their conduct if they have a mental illness which inhibits their understand-
ing of the wrongfulness of their behavior. This approach is also problem-
atic since it can be argued that antisocial individuals do understand the
wrongfulness of their acts, as evidenced by the fact that they try to avoid
getting caught. To be sure, there is a wide gap between the APA's
guidelines of mental disorder and what the court system is willing to
officially designate as legal insanity. Consequently, many mentally ill peo-
ple are sent to prison just as they were centuries ago.
Prevalence
It is imposible to know the real number of antisocial personalities in
the United States since they are not the type of people who seek treatment
on their own. If they are treated, it is usually after having been caught by
authorities and referred for psychiatric evaluatiolil. Thus those antisocial
personalities who are never arrested go unrecognized. Additionally, those
who are arrested but not adjudged in need of psychiatric care are also over-
looked because of the unrealistic legal guidelines which determine criminal
responsibility. Apparently the rate of this disorder is rising if the national
crime rate can be used as a rough barometer, although some crime is
carried out by "normal" people.
From records of diagnosed antisocial personalities, it is reported that
most come from lower class families living in slum areas. The prevalence by
sex is predominantly male. Estimates are that ten times as many males as
females are diagnosed as antisocial.'" The condition occurs more frequently
in males with muscular, athletic builds, the mesomorphic physique. Typi-
cally, the antisocial behavior is manifested before the age of fifteen. There
is also a high rate of antisocial personality types reported among adopted
children.
THE BIOGENIC VIEW OF ANTISOCIAL BEHAVIOR
EEG Abnormalities
There have been a number of attempts to assess whether antisocial
disorder is caused by biogenic factors. Some researchers note that criminal
antisocials frequently have a history of head injury or epilepsy. The rela-
tionship between antisocial behavior and brain tissue impairment has been
further demonstrated by a number of studies using electroencephalo-
graphic (EEG) procedures to record the electrical activity of the brain. In
thirteen of fourteen such studies, antisocial individuals showed some form
of EEG abnormality.'1 The proportion of subjects with abnormal patterns
'''Marshall B. Jones, David, R. Offord and Nola Abrams, "Brothers, sisters and ailliso-
cial behaviour,'.' Briti5h ./ournal of Psychiatry, 136 (1980), pp. 139- J 45. Some repon that the
antisoCIal condition IS not more common among males. See: Donllhy O. Lewis, Shelley R.
Shanok and Jonathan H. Pincus, "A comparison of the neuropsychiatric status of female and
male incarcerated delinquents: some evidence of sex and race bias," ./ollnut.! of the Ame>1ml/.
Academy of Child Psychiatry, 2( I 982), pp. 190-1 Yfi.
"R. J. Ellingson, "Incidence of EEG abnormality among patients with mental disorders
of apparently nonorganic origin: a criminal review," All/aim/! joumal of P.I~rhiatry, 3 (1954),
pp. 263-275. . .
132 Personality Disorders
Personality Disorders 133

of brain activity ranges from 31 to 5H percent in various studies. In this between the antisocial diagnosis and the XYY pattern may be due to the
connection, one report further finds that EEG abnormalities vary with type physical traits exhibited by these men; they are frequently large and rid-
of antisocial traits; fire-setting is associated with high EEG abnormality, dled with acne, both of which may predispose evaluators (such asjudges) to
while stealing is associated with low EEG abnormality. I', However, it is ques- see them as deviants. Of course, there are many males born with the XYY
tionable whether the EEG procedure is a valid way of assessing those activi- factor who do not turn to a life of crime.
ties of the brain related to thought and behavior since it records only a
small sample of activity from the brain surface. Biochemical Theory

Genetic Theory There is an additional explanation of antisocial behavior which is bio-

In the 1930s, studies of hereditary influences were conducted on chemical. Lykken has demonstrated that antisocial personality types expe-
monozygotic twins. Lange found thirteen antisocial criminals in Germany rience less anxiety about socially unpleasant situations than do normal peo-
each of whom had an identical twin. Ten of the thirteen co-twins were anti- ple.~' It is possible that antisocials are less sensitive to social mores due to a
social themselves. "' However, a study of nineteen monozygotic twin pairs in defect in the autonomic nervous system that in turn reduces arousal levels.
the United States did not support a genetic explanation of the antisocial If this is true, then they should act like normal people in their response to
disorder.17 The twins in the United States' study had been separated at an socially unpleasant situations when their anxiety levels are increased. This
early age and raised separately. No significant concordance for the antiso- hypothesis was tested by Schachter and Latone who injected a group of an-
tisocial personalities with adrenalin, a chemical agent which stimulates the
cial disorder was demonstrated, leaving the theory of genetic transmission
autonomic nervous system.~~ Under the inAuence of adrenalin, individuals
open to question. The results of another German study, this one by Kranz,
also points toward the importance of environmental factors.1X Kranz found in the group exhibited increased anxiety in response to socially unpleasant
a 54 percent rate of concordance among fraternal twins of the same sex but situations. It is possible that their thirst for excitement and their inability to
deal with boredom and routine may be the result of a biochemical state of
only a 14 percent rate among fraternal twins of the opposite sex. The
marked difference between concordance rates of same-sex fraternal twins lowered arousal. In this view, then, their "thrill-seeking" behavior may be
an attempt to increase their level of arousal to a normal state.
and opposite-sex fraternal twins is critical because it demonstrates the
greater effect of differing child-rearing practices over genetic similarity. It has been demonstrated experimentally that antisocial people per-
In the 1980s genetic factors have been reinvestigated. One study form less well than do normal people in tedious, monotonous tasks,"" and
studies also show that they clearly prefer novel situations over familiar
found that genes may contribute to antisocial behavior in the presence of
adverse environmental factors.'" Another report suggests there may be a ones.~' It is clear that antisocial people do not have the same emotional
biological link between schizophrenia and antisocial personality.~11 But make-up as most people since they feel no anxiety in response to behavior
which normally elicits guilt. It is unclear, however, whether this is a direct
probably the most interesting genetic theory is the XYY proposition. The
central thesis of this theory is that antisocial persons, who are usually males, result of a neural dysfunction. If it is, the specific biochemical alterations
have an extra male (Y) chromosome. This chromosomal abnormality have yet to be uncovered. It is more likely that any abnormalities in their
(XYY) is believed to cause aggressive behavior which can lead to antisocial nervous systems are in response to pathologic hlCtors in the psychosocial
acts. However, the XYY pattern, considered to produce "supermales," does environment since there are simply too many common family background
not account for many cases of antisocial disorder. Perhaps only one percent features among antisocial individuals to justify a purely biochemical expla-
nation.
of antisocial criminals have this chromosomal make-up. In fact, any link-up

"'David Abrahamsen, TI/(' /'.lydlOlogy of Crill/I', pp. 1:\8-1 :19.

~'D. 1'. Lykken, "A study of anxiety in the sociopathic personality,".Iolll'lllll of Almol'll/III
"J. Lange, Cr;me ILl Oe.ltiny (London: Gcorgc Allen, 1~)31). and Sor;1I1 P.lyc/tology, 55 (1957), pp. 6-10.
"II. II. Newman, f. N. Frccman, and K. J
Iioilinger, 'I'",il/,\: A Study oj Hl'I'edity Ilnd "S. Schachter and B. Latonc, "Crime, cognition, and the autonomic ncrvous system," in
Environment (Chicago: Chicago Univcrsit y Prcss, 19:17). Nebra.I/W SYllljJOS;UIII Oil Motivation,
Press, 19(4). ed. D. Levinc, vol. 12 (Lincoln: Univcrsity of Ncbraska
"1-1. Kranz, Leben.lflt;rklflle K I'im;nelll'l' Zw;lIiI/W' (Berlin: Springcr- Verlag, 19:16).
'"Remi J. Cadoret, Collcen A. Cain, and Raymond R. Crowe, "~vidence for gene- ".I. B. Ovvis, "Visua!moniloring per!()rmance in thrce subg-roups of malc delinquents"
cnvironment interaction in the development of adolcscent antisocial behavior," fJeluw;ol' Genet- (unpublished master's thesis, University of Illinois, 19(7).
irs, 13 (1983), pp. 301-310. ~IG..I. Skrzypek, "The effects of perceptual isolation and arOllsal on anxicty, complcx-
"l Rimmer and Bjorn Jacobscn, "Antisocial pcrsonality in thc biological relatives of ity preference
Abnormal
and
P;yrlwlogy,
novelty preference in psychopathic
74 (1969),pp. 321-329.
and ncurotic dclinqucnts," ./ouI'I1II1 of
schizophrenics," Com/JI'eltemive P.'yrltilltI'Y, 21 (1980), pp. 258-262.
134 Personality Disorders Personality Disorders 135

THE ENVIRONMENTAL VIEW OF ANTISOCIAL BEHAVIOR Parental Hypocrisy Theory

A second environmental theory consists of both psychoanalytic and

Psychoanalytic Theory behaviorist concepts. The central proposition of this theory is that children
Psychoanalytically, antisocial behavior is viewed as the improper re- learn antisocial behavior from parents who encourage and reward it. In
sponse of the ego and superego to id impulses, resulting from a poorly this sense, the disorder develops through conditioning and positive rein-
formed superego which leaves the ego at the mercy of the instincts. Conse- forcement. The other side of the theory is that parents who encourage anti-
quently, the ego is not able to tolerate instinctual tension or to postpone social behavior do so unconsciously for they achieve vicarious gratification
instinctual gratification.2·' Since the superego is defective, there is no inner of their own forbidden, repressed impulses through their child's acting out
mechanism to regulate life activities according to moral principles or social behavior. Therefore, the latent antisocial parent produces the manifest an-
norms. Antisocial personalities have only an "external superego," that is, a tisocial child. This theory assumes that the superego develops through the
fear of being caught by the law. Because they lack a healthy superego, these incorporation of the parents' covert behaviors as well as their manifest be-
people are constantly overwhelmed by the need for pleasure. This is the haviors. For example, the parent who immediately checks to see that a child
psychoanalytic explanation of their "thrill-seeking" behavior. Consistent has followed an order and who constantly warns of dire consequences, si-
with this theory, one researcher estimates that 90 percent of antisocial multaneously conveys an unstated alternative to the order, namely disre-
males are driven by sexual tension.2(; What causes the superego defect? The gard [or authority.2" Thus, it is parental hypocrisy that corrupts the super-
common psychoanalytic explanation is that, as a child, the antisocial was ego. The parents condemn antisocial behavior overtly while they
denied the normal opportunity to form a close relationship with a parental simultaneously encourage it covertly. One team of researchers states, "It is
figure. Thus, the individual never incorporates the set of moral standards possible in every case adequately studied to trace the specific conscience de-
which usually result from normal phallic experiences and from fect in the child to a mirror image of similar type and emotional charge in
identification with the same-sex parent. Numerous situations can create the parent."o The same researchers cite some common examples of the
this type of deprivation. For example, when a child is repeatedly moved ways in which the parents of antisocial individuals encourage immorality
from one foster home to another, he is not provided with any stable paren- such as, " 'Here is an extra quarter, but don't tell your father; 'You can get
tal figure after which to model himself. This kind of parental deprivation into the movie for half-price, since you certainly don't look 12 years old';
appears quite frequently in antisocial personality types. In fact, one study 'Fires are dangerous but if you must get it out of your system, then we'll set
revealed that 60 percent of a sample of antisocial personalities had lost at some in the yard' ... Children hear their parents gloating about
least one parent during childhood.27 shortchanging the grocer; naturally they sense the parental pleasure."'"
Psychoanalysts believe improper parenting is the primary cause of the Clinical observations of antisocial children who are being treated to-
antisocial disorder. Some research does report a marked association be- gether with a parent support the theory of parental hypocrisy. In some
tween the disorder and a lack of parental affection. One such study com- cases the parent showed unmistakable joy while the child was telling the
pared attitudes of antisocial boys and normal schoolboys toward their fa- therapist about misdeeds. Immediately after the report, however, the par-
ent became moralistic and condemned the child's behavior."2 In other in-
thers.2~ A significantly larger number of the antisocial boys felt that their
fathers were disinterested in them. Further evidence suggests that the anti- stances, the parent encouraged the child to relate misdeeds in graphic de-
social individual is often a child born to parents who did not want him. He tail, provided missing pieces of information and openly eruoyed the
lawbreaking of the child.
is frequently either an illegitimate birth or a child born to parents with a
bad marriage. As a result, he is often passed between a series of temporary It is not difficult to understand how parental hypocrisy can foster a
"caretakers" or institutionalized. defective superego. Parents who verbally support one set of values but who
act according to another can not hope that their children will respect moral
principles. A father who lectures on honesty while bragging about an abil-
ity to evade income taxes or a mother who appears to be astounded when
she hears a four letter word but who promiscuously performs the act it
2"l-Ierman Nunbeq~, Prinri/Jles or P.\yclwall.alysi.\, (New York: International Universities
Press, 1955), p. 309.
2"Mary E. (;riffin, Adelaide M. Johnson, and Edward M. Litin, "The transmission of
2liCIinton T. Duffy, "Scx as thc cause of most crime," in Sex: MalelGender: Masculine:
superego dcfects in the family," in A Modem II/troduction to the Fall/ily, eds. Norman W. Bell and
Readings in Male Sexuality, ed. John W. Petras (Port Washington, N.Y.: Alfred Publishing Co.,
Erza F. Vogel (New York: The Free Press, 19(8), pp. 670-682.
1975), pp. 38-45. '\1'1 bid., p. 671.
27S. Greu, "Study of parental loss in neurotics and sociopaths," Archives of General Psychi-
"Ibid., p. 675.
atry, II (1964), pp. 177-180.
2KR. G. Andry, Delinquf'llcy and Parl'lltal Pathology (London: Methuen, 19(0). :l2Norman Cameron, Pemmality Develo/Jlnent and P.lycho/lathology, p. 654.
136 Personality Disorders Personality Disorders 137

symbolizes is likely to raise children who harbor resentment toward author- the moral fibre of the community in which the child is socialized may be an
ity figures. im portan t etiological factor.
The psychoanalytic parental rejection theory seems to be a useful ex-
planation of antisocial behavior in the lower classes in which there are en- Prognosis
tire families of antisocial personalities. The parental hypocrisy model, how-
The antisocial disorder begins in early childhood when a number of
ever, may be more appropriate to the etiology of the disorder in middle
indications of the psychopathology appear. Iii These children are emotion-
class families where often only one sibling in a family manifests the disor-
der, while other siblings are well-adjusted. "I This may be the result of one ally immature and often react to small frustrations with violent temper tan-
child being selected as the scapegoat for the parents' own forbidden de- trums. They are frequently deceitful, boastful, destructive, quarrelsome,
sires. This explanation makes particular sense in light of the high rate of and defiant. Their condition reaches a peak in adolescence and typically
subsides in the late twenties. There are only a few older antisocial individu-
antisocial behavior among adopted children." The attitudes which parents
manifest toward adopted children are likely to be quite different from their als in society. This occurs for one of two reasons. First, many have been
attitudes toward their natural children. Such parents are often hostile to- placed in prisons or mental hospitals before they reach middle age, and
second, for unknown reasons, some "level off' or "burn out" in later life
ward each other as well. This hostility may either lead to childlessness or be
and cease to exhibit antisocial behavior. In general, however, the chances
the consequence of it. In either case, adopted children can not overcome
for recovery are very poor because this condition is particularly difficult to
the problem of childlessness since they do not verify the biologic and sexual
identity of the parent. Rather, they serve as a living reminder of the par- treat. For this reason, many hospitals avoid admitting antisocial people. If
ent's own inadequacies. Small wonder they are often not cared for lovingly. they are admitted, hospitals are unwilling to treat them far long periods of
time because they upset other patients.'7 In the literature there are only
scattered reports of successful treatment of antisocials. Those who do re-
Labeling Theory port success typically use a therapeutic approach involving discipline and
pu n ish men t.:1X
Labeling theory posits that the behavior of antisocials is fashioned by
the attitudes of significant others toward them. If children are rejected by
their parents or by the community, they may live up to the bad name given BORDERLINE PERSONALITY DISORDER
them by others. This serves to establish some sort of identity, although it is
a negative one. Labeling theorists do not believe that family experience is
In DSM-III, borderline personality disorder is listed as a condition in
the complete cause since many children who are raised by rejecting or in-
consistent parents do not become antisocial. Furthermore, they contend, which there is instability in a variety of areas, including mood,
the family is not the exclusive source of social norms but part of the larger interpersonal behavior, and self-image. This personality type can be found
together with other disorders such as schizotypal, histrionic, narcissistic,
community whose norms it reOects. Children who are reared in the slum of
and antisocial personality disorders.
a city are raised in a community which rewards crime and pleasure-seeking
while ignoring ethical standards of the larger society. Since there is a high Five of the fallowing eight characteristics are necessary for this diag-
rate of antisocial behavior among poor people living in slum areas, this nosis (I) impulsivity in self-damaging areas such as sex, spending, gambling
theory certainly has some value. Some antisocial people may be simply act- sprees, and shoplifting (2) shifts of attitude toward others (3) inapproprate
anger (4) uncertainty about identity issues, such as self-image, gender iden-
ing out a role rewarded by their community. This argument is even more
compelling when the city slum is contrasted with life in an entirely different tity, and friendship patterns (5) mood shifts, usually lasting a few hours (6)
intolerance of being alone (7) physically self-damaging acts such as self-
setting. The religious sect of the I Iutterites provides such a contrast. The
mutilation and physical fights and (8) chronic feelings of boredom.
Hutterites are an isolated Anabaptist sect who live a simple rural life in the
As a recently identified personality disorder, little information exists
midwestern United States. The children are raised with strict discipline,
suffering penalties for any infringement of moral law. Among these people about causal factors, although it is known that borderline personality is
more commonly diagnosed in women.
there is a complete absence of antisocial personalities. I', This suggests that

"'Chances for recovery are discussed for this condition because of the important impact
·I"L. C. Kolb, Modern Clinical P.\ycitilll'y. antisocial personalities have on society.
"'Remi J. Cadoret and Colleen A. Cain, "Sex differences in prediclOrs of antisocial be- •17H. B. Kidd, Violence and Ihe Menial Health Service.\ (London: L.A.M.II., 1962).
havior in adoptees", ArcitivI's of Gel/eml P.\ycitililry, :\7 (19HO), pp. 1171-1175. '"Frederick C. Thorne, "The etiology of sociolpathic reactions," in SourcI,book in AbwJr-
"Joseph Eaton and Roben J Wcil, "The mental health of the Ilutlerites," Scientific mal Psychology. eds. Leslie Y. Rabkin and .John E. Carr (BoslOn: IloughlOn
276-2H2. Mifflin, 1967), pp.
American, 189 (1953), pp. 31-37.
138 Personality Disorders
AVOIDANT PERSONALITY DISORDER
This disorder occurs among people who are hypersensitive to rejection,
humiliation or shame and, as a consequence, they are socially withdrawn
and unwilling to enter into relationships unless they are guaranteed of
uncritical acceptance. Unlike people with schizoid personality disorder
(who are socially isolated because they have no desire for interaction with
others) avoidant personalities actually yearn for affection and acceptance.
Although this is a reportedly common disorder, little is known about its eti-
ology.
DEPENDENT PERSONALITY DISORDER
Dependent personalities are people so lacking in self-confidence that they
passively allow others to make m;;uor life decisions for them. For example,
they may allow a spouse to decide what kind of job they should have, where
they should live, and whom they should choose for friends. The problem
may proceed to the point where a person with dependent personality disor-
der may tolerate a physically abusive husband for fear that he will leave
her. It is not unusual for these people to lack self-confidence so much that
they constantly demean themselves as being "stupid." This disorder is ap-
parently common, and is diagnosed more frequently, in women.
COMPULSIVE PERSONALITY DISORDER
This behavior pattern is characterized by excessive concerns with neatness,
orderliness, and punctuality. These people are social conformists who have
a strict adherence to standards of conscience. They are not merely hard-
working individuals; they neglect other aspects of life for the sake of work.
When they help others, they do so not for purely altruistic reasons; it is a
sense of duty that motivates them, rather than affection or true altruism.
These people are unable to relax easily outside of work. As a conse-
quence, they have few recreations. When they do join a social organization,
they are attracted to roles which reflect their personality, such as secretary,
treasurer, or other duties requiring organization and detail. Their preoc-
cupation with detail, rules, and regulations dampens their creativity and
restricts their aspirations to nonleadership positions. As Eaton and
Peterson state, " ... these are not people who 'fail to see the forest for the
trees'; they fail to see the tree while counting its leaves.""~1
Compulsives can not tolerate ambiguity and have difficulty making
decisions. For these reasons, they avoid or delay marriage because a suita-
ble mate must have precise qualities. When they do marry, the spouse is
typically a compliant, dependent person who perceives the compulsive as
strong and self-reliant.
""¥en'ill T. Eaton,Jr. and Margaret I I. Peterson, Psychiatry (New York: Medical Exami-
nation Publishing Company, Inc., 1969), p. 12H.
Personality Disorders 139
When their organized system of living breaks down, these people may
develop the obsessive compulsive disorder. If a stress occurs during the
middle age years, depression is a more likely result. The compulsive per-
sonality differs from the obsessive compulsive disorder in that there is an
absence of severe obsessions and compulsions in the former. As such, the
compulsive personality disorder is less debilitating.
Unique to compulsive personalities is their tendency to mix a compul-
sive characteristic with its opposite; compulsive disorderliness may coexist
with compulsive neatness; a compulsive spendthrift may be compulsively
stingy at other times. Like the obsessive compulsive disorder, some link this
condition to fixations from a childhood struggle with the parents over
bowel control. This produces the so-called "anal character" who is exces-
sively neat and stubborn. The other popular explanation is the behaviorist
view that compulsives imitated parents who were hard-working and
inflexible themselves. The disorder is reportedly common and is diagnosed
more frequently among men.
PASSIVE-AGGRESSIVE PERSONALITY DISORDER
This disorder can be subdivided into three types: the passive-dependent, the
passive-aggressive, and the aggressive. Passive-dependents act like helpless,
grown-up babies who frighteningly look to others for direction. These are
the "clinging vines" who can never assume responsibility for their own ac-
tions. The behavior may not be disabling; it may even be socially useful.
There are many employers, for instance, who seek employees who ask for
orders and follow them out. The people, in turn, are content as long as
they are not promoted.
Passive-aggressive types, as the name implies, are aggressive in a
passive way. They are stubborn and very uncooperative toward authority
figures who are perceived as domineering tyrants. In school, these people
may not openly refuse to do an assignment, but they grudgingly comply, all
the while complaining and procrastinating. Pouting is also common. This
type is attracted to such passive-aggressive activities as sit-down strikes.
This is a disabling psychopathology as evidenced by its frequent role in ed-
ucational, occupational, and marital failure. II)
The aggressive type is overbearing, rude, sarcastic, and argumenta-
tive. Temper outbursts are common, and this person can become destruc-
tive with little provocation. Some of these cases overlap with antisocial and
explosive behavior. People with the passive-aggressive disorder show both
aggressive and dependent behavior in different circumstances. For this
reason, the underlying problems of the different types are considered to be
the same. It is very difficult to estimate the prevalence of this psychopathol-
ogy but some experts contend that it is one of the most common psychiatric
disorders. 'I It only stands to reason that the number of disorders involving
aggressive activity is rising as modern society increasingly restricts open ex-
'''Merrill T. Eaton, Jr. and Margaret H. Peterson, P.\.vrhiatI'Y, p. 124.
"Ibid., p. 121.