What is Anal Retentiveness?

Introduction

An anal retentive person is a person who pays such attention to detail that it becomes an obsession and may be an annoyance to others.

The term derives from Freudian psychoanalysis.

Origins

In Freudian psychology, the anal stage is said to follow the oral stage of infant or early-childhood development. This is a time when an infant’s attention moves from oral stimulation to anal stimulation (usually the bowels but occasionally the bladder), usually synchronous with learning to control its excretory functions – in other words, any form of child training and not specifically linked to toilet training. Freud posited that children who experience conflicts, in which libido energy is under-indulged during this period of time, and the child is perhaps too strongly chastised for toilet-training accidents, may develop “anal retentive” fixations or personality traits. These traits are associated with a child’s efforts at excretory control: orderliness, stubbornness, and compulsions for control. Conversely, those who are overindulged during this period may develop “anal-expulsive” personality types.

Influence and Refutation

Freud’s theories on early childhood have been influential on the psychological community; the phrase anal retentive and the term anal survive in common usage. The second edition of the Diagnostic and Statistical Manual (DSM-II) introduced obsessive-compulsive personality disorder (OCPD), with a definition based on Freud’s description of anal-retentive personality. But the association between OCPD and toilet training is largely regarded as unsupported “pop-psychology” and therefore discredited by the majority of psychologists of the late 20th and early 21st centuries. There is no conclusive research linking anal stage conflicts with “anal” personality types.

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What is Introjection?

Introduction

In psychology, introjection is the unconscious adoption of the thoughts or personality traits of others.

It occurs as a normal part of development, such as a child taking on parental values and attitudes. It can also be a defence mechanism in situations that arouse anxiety.

The tendency is also known as identification or internalisation. It has been associated with both normal and pathological development.

Theory

Introjection is a concept rooted in the psychoanalytic theories of unconscious motivations. Unconscious motivation refers to processes in the mind which occur automatically and bypass conscious examination and considerations.

Introjection is the learning process or in some cases a defence mechanism where a person unconsciously absorbs experiences and makes them part their psyche.

Introjection in Learning

In psychoanalysis, introjection (German: Introjektion) refers to an unconscious process wherein one takes components of another person’s identity, such as feelings, experiences and cognitive functioning, and transfers them inside themselves, making such experiences part of their new psychic structure. These components are obliterated from consciousness (splitting), perceived in someone else (projection), and then experienced and performed (i.e. introjected) by that other person. Cognate concepts are identification, incorporation and internalisation.

Introjection as a Defence Mechanism

It is considered a self-stabilising defence mechanism used when there is a lack of full psychological contact between a child and the adults providing that child’s psychological needs. Here, it provides the illusion of maintaining relationship but at the expense of a loss of self. To use a simple example, a person who picks up traits from their friends is introjecting.

Projection has been described as an early phase of introjection.

Historic Precursors

Freud and Klein

In Freudian terms, introjection is the aspect of the ego’s system of relational mechanisms which handles checks and balances from a perspective external to what one normally considers ‘oneself’, infolding these inputs into the internal world of the self-definitions, where they can be weighed and balanced against one’s various senses of externality. For example:

  • “When a child envelops representational images of his absent parents into himself, simultaneously fusing them with his own personality.”
  • “Individuals with weak ego boundaries are more prone to use introjection as a defense mechanism.”

According to D.W. Winnicott, “projection and introjection mechanisms… let the other person be the manager sometimes, and to hand over omnipotence.”

According to Freud, the ego and the superego are constructed by introjecting external behavioural patterns into the subject’s own person. Specifically, he maintained that the critical agency or the super ego could be accounted for in terms of introjection and that the superego derives from the parents or other figures of authority. The derived behavioural patterns are not necessarily reproductions as they actually are but incorporated or introjected versions of them.

Torok and Ferenczi

However, the aforementioned description of introjection has been challenged by Maria Torok as she favours using the term as it is employed by Sándor Ferenczi in his essay “The Meaning of Introjection” (1912). In this context, introjection is an extension of autoerotic interests that broadens the ego by a lifting of repression so that it includes external objects in its make-up. Torok defends this meaning in her 1968 essay “The Illness of Mourning and the Fantasy of the Exquisite Corpse”, where she argues that Sigmund Freud and Melanie Klein confuse introjection with incorporation and that Ferenczi’s definition remains crucial to analysis. She emphasized that in failed mourning “the impotence of the process of introjection (gradual, slow, laborious, mediated, effective)” means that “incorporation is the only choice: fantasmatic, unmediated, instantaneous, magical, sometimes hallucinatory…’crypt’ effects (of incorporation)”.

Fritz and Peris

In Gestalt therapy, the concept of “introjection” is not identical with the psychoanalytical concept. Central to Fritz and Laura Perls’ modifications was the concept of “dental or oral aggression”, when the infant develops teeth and is able to chew. They set “introjection” against “assimilation”. In Ego, Hunger and Aggression, Fritz and Laura Perls suggested that when the infant develops teeth, he or she has the capacity to chew, to break apart food, and assimilate it, in contrast to swallowing before; and by analogy to experience, to taste, accept, reject or assimilate. Laura Perls explains: “I think Freud said that development takes place through introjection, but if it remains introjection and goes no further, then it becomes a block; it becomes identification. Introjection is to a great extent unawares.”

Thus Fritz and Laura Perls made “assimilation”, as opposed to “introjection”, a focal theme in Gestalt therapy and in their work, and the prime means by which growth occurs in therapy. In contrast to the psychoanalytic stance, in which the “patient” introjects the (presumably more healthy) interpretations of the analyst, in Gestalt therapy the client must “taste” with awareness their experience, and either accept or reject it, but not introject or “swallow whole”. Hence, the emphasis is on avoiding interpretation, and instead encouraging discovery. This is the key point in the divergence of Gestalt therapy from traditional psychoanalysis: growth occurs through gradual assimilation of experience in a natural way, rather than by accepting the interpretations of the analyst.

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What is Dispositional Affect?

Introduction

Dispositional affect, similar to mood, is a personality trait or overall tendency to respond to situations in stable, predictable ways.

This trait is expressed by the tendency to see things in a positive or negative way. People with high positive affectivity tend to perceive things through “pink lens” while people with high negative affectivity tend to perceive things through “black lens”. The level of dispositional affect affects the sensations and behaviour immediately and most of the time in unconscious ways, and its effect can be prolonged (between a few weeks to a few months).

Research shows that there is a correlation between dispositional affect (both positive and negative) and important aspects in psychology and social science, such as personality, culture, decision making, negotiation, psychological resilience, perception of career barriers, and coping with stressful life events. That is why this topic is important both in social psychology research and organiaational psychology research.

Characteristics

Conceptual Distinctions from Emotion and Mood

Besides dispositional affect, there are other concepts for expressions of emotion such as mood or discrete emotions. These concepts are different from dispositional affect though there is a connection among them.

Dispositional affect is different from emotion or affect, by being a personality trait while emotion is a general concept for subjective responses of people to certain situations.Emotion includes both general responses (positive or negative emotion) and specific responses (love, anger, hate, fear, jealousy, sadness etc. The strength of emotions a person feels can stem from his level of dispositional affect.
Dispositional affect is also different from moods since mood relates to general feeling that usually tends to be diffusing and not focused on a specific cause or object.Though mood is specific, it is not a personality trait. Still, positive affectivity can explain why a person has good mood in general, since positive affectivity means viewing the world in a good light. The same thing is true for negative affectivity, which can explain why a person has bad mood in general, since negative affectivity means viewing the world in a dark light.

Dimensions

In general, though emotion researchers disagree about the way that emotions and dispositional affect should be classified, a common classification of emotions assumes that each emotion is a combination of pleasantness (pleasant or unpleasant) and activation (high or low). For example, excitement is a combination of pleasantness and high activation, while calmness is a combination of pleasantness and low activation. Dispositional Affect is also a combination of pleasantness and activation. According to this classification, the different combinations of high or low pleasantness and high or low activation create four Quarters. In line with the classification mentioned above, there is a well-known and common model that is being used in organisational psychology research to analyse and classify dispositional affect, which was developed by Watson and Tellegen. The researchers claim that there are two dimensions of dispositional affect: positive affectivity and negative affectivity and that each person has a certain level of both positive affectivity and negative affectivity. Hence, according to the model and contrary to intuition, positive affectivity does not represent the opposite of negative affectivity, but a different aspect from it. According to Watson & Tellegen one must regard these quarters as two pivots which determine the positive affectivity and negative affectivity of a person. These two dimensions of dispositional affect are bipolar, distinct and independent, relating to different emotion groups, so that each person can be classified with a positive affectivity and negative affectivity grade.

Positive AffectivityDescribes a person’s tendency to be cheerful and energetic, and who experience positive moods, (such as pleasure or well-being), across a variety of situations, perceiving things through a “pink lens”. Individuals who have low levels of positive affectivity tend to be low energy and sluggish or melancholy. High level of positive affectivity represents the extent to which an individual feels energetic and excited, while low level of positive affectivity represents the extent to which an individual feels sadness, sluggishness or weariness”.
Negative AffectivityDescribes a person’s tendency to be distressed and upset, and have a negative view of self over time and across situations, perceiving things through a “black lens”. It is important to explain that low levels of negative affectivity are perceived as positive traits since they represent individuals who are more calm, serene and relaxed. High levels of negative affectivity represents the extent to which an individual feels anger, irritability, fear or nervousness, while low level of negative affectivity represents the extent to which an individual feels calm and serene”.

Relation to Personality Traits

There has been some debate over how closely related affect and some of the Big Five Model of personality traits are related. Some maintain that negative affect and positive affect are should be viewed as the same concept as Neuroticism and Extraversion from the Big Five Model, respectively. However, other researchers maintain that these concepts are related but should remain distinctly separate as they have traditionally had weak to moderate correlations, around.

Measurement

Operationalisations for dispositional affect can be measured by questionnaires. In English researchers use the Positive Affect Negative Affect Scale (PANAS). According to the instructions of this questionnaire, the individual is asked to indicate to what extent he or she feels a certain feeling or emotion such as happy, sad, excited, enthusiastic, guilty, distressed, afraid, etc. An individual has to indicate the most appropriate answer to each item (feeling or emotion) on a scale ranging from 1-5 (1- Very slightly or not at all, 5- Extremely). Early mapping of these emotions by the researchers, helps determine the positive affectivity and negative affectivity of the individual. Another advantage that was discovered while developing this questionnaire is that though it is intended for personality analysis, people can respond to the questions according to specific time frames, for example people can indicate the emotions or sensations they feel at this moment, in the past week, or in general. This way we can learn about dispositional affect to a certain situation and not only about dispositional affect as a general personality trait. By responding to the questions about feelings “in general” we can learn about positive and negative affectivity as a personality trait. By responding to the questions about feelings “at this moment” we can learn about situational dispositional affect as a response to a certain situation. For example, Rafaeli et al. showed in their research that waiting in line cause an increase in negative affectivity levels.

Physical and Mental Aspects

AspectOutline
Physical healthWhen it comes to people with different illness, it is interesting to see that there are differences in the physical health according to the levels of dispositional affect. Individuals who have high levels of positive affectivity, had longer life span, reported fewer pains and illness symptoms (such as blood pressure), and were less likely to develop a cold when exposed to a virus compared with individuals who have high levels of negative affectivity, while both had the same illness. It was also discovered that when it comes to people with chronic diseases that has decent prospects for long-term survival, (such as coronary heart disease), people may benefit from high levels of positive affectivity. However, when it comes to people with chronic diseases that has short-term prognoses (e.g. metastatic breast cancer) and poor survival chances, high levels of positive affectivity may be detrimental to the health of these individuals, possibly as a consequence of underreporting of symptoms resulting in inadequate care, or of a lack of adherence to treatment.
LifestyleEven when it comes to healthy individuals, it seems that there are differences between people’s life style, due to their dispositional affect trait. Individuals who have high levels of positive affectivity tend to attend healthier activities such as improved sleep quality, more physical exercise, and more intake of dietary vitamins, and tend to socialise more often and maintain more and higher-quality social ties. It was also found that high levels of positive affectivity may result in more and closer social contacts because it facilitates approach behaviour, and because others are drawn to form attachments with pleasant individuals.
Psychological ResilienceIndividuals who have high levels of positive affectivity have lower levels of the stress hormones (such as epinephrine, norepinephrine, and cortisol), thus physiology gives one explanation in favour of psychological resilience that provides positive resources to confront stressful life events. On the other hand, the broaden-and-build theory provides a different explanation from the physiological one, and claim that individuals who have high levels of positive affectivity and experience positive events in the present, create a spiral or “snow ball” effect, that may lead to higher probability to experience positive events in the future as well. This means that happiness and well-being sensations in the present, are the ones which creates the likelihood to feel the same in the future, which helps us in building a strong and improved system of coping with stressful life events.
Dispositional Affect and the WorkplaceSome studies have suggested that worker’s perceived career barriers might be due to their dispositional affect.
Positive/Negative AffectNegative affect (NA) is said to have some relation with positive affect (PA), however the actual answer to that is still up in the air. Research of negative affect noted that the contents related to specific-situation in a negative way.
CopingSome studies have found a relationship between Dispositional affect and the coping mechanisms used in attaining ones goals. Those with a positive dispositional affect were more successful in using task-oriented coping methods ( which involve directly addressing the issue at hand), while those with a negative dispositional affect were more successful in using avoidant coping strategies (which involve managing stressful situations in an indirect way).

Culture

Though it is agreed that there are differences between one culture and another, most of the differences that were addressed in researches are related to the comparison between individualism and collectivism. In individualistic cultures, it was found that there is a strong relationship between dispositional affect (either positive or negative) and general life satisfaction (though the relationship was stronger for positive affectivity compared to negative affectivity). On the other hand, in many collectivistic cultures, it was found that there is a no relationship between negative affectivity and general life satisfaction, and it may result from the great variance in the ways that different cultures regulate their positive affectivity compared to negative affectivity.

Decision Making and Negotiation

Decision-MakingIn dealing with interesting and important situations, it was found that individuals who have high levels of positive affectivity make a thorough and efficient cognitive processing, and therefore their decision making process is more efficient, flexible, creative and innovative. It was also found that positive affectivity facilitate creativity, cognitive flexibility, novel responses, openness to new information and dealing with mental problems. This stems from the fact that positive affectivity encourages problem solving approach and searching for variety, in order to achieve a suitable result. At last, it was found that high levels of positive affectivity does not encourage risk taking, though it does facilitates negotiation processes, and improves the results of face to face negotiation processes, in order to reach to agreement.
NegotiationWhen individuals negotiate, it was found that high levels of positive affectivity was related to optimistic view of the upcoming results, planning and using cooperation strategies, and better results regarding the agreements that were made, both in personal (and not formal) negotiation, and group (formal) negotiation. It was also found that positive affectivity increases the likelihood to use cooperation strategies (but not other strategies such as “an eye for an eye”) and improves the results of the negotiation, even if just one of the negotiators has the desired trait of positive affectivity, and increases the likelihood and willingness to agree with counter–arguments, and behaviour changes as a result. Another support for the findings presented above, showed that high levels of positive affectivity was related to willingness to compromise and give up, finding creative solutions, using cooperative strategies, less cheating and better results in negotiation processes. On the contrary to the findings about positive affectivity, it was found that high levels of negative affectivity was related to usage of competitive strategies, and much worse results regarding the agreements that were made. Another support for these finding showed that high levels of negative affectivity was related to competition, lower offers, rejecting ultimatums and lower combined gains, as a result of the negotiation process, and minimum willingness to continue the cooperation strategy in the future.

What is Personality Psychology?

Introduction

Personality psychology is a branch of psychology that examines personality and its variation among individuals. It aims to show how people are individually different due to psychological forces. Its areas of focus include:

  • Construction of a coherent picture of the individual and their major psychological processes;
  • Investigation of individual psychological differences; and
  • Investigation of human nature and psychological similarities between individuals.

“Personality” is a dynamic and organised set of characteristics possessed by an individual that uniquely influences their environment, cognition, emotions, motivations, and behaviours in various situations. The word personality originates from the Latin persona, which means “mask”.

Personality also pertains to the pattern of thoughts, feelings, social adjustments, and behaviours persistently exhibited over time that strongly influences one’s expectations, self-perceptions, values, and attitudes. Personality also predicts human reactions to other people, problems, and stress. Gordon Allport (1937) described two major ways to study personality: the nomothetic and the idiographic. Nomothetic psychology seeks general laws that can be applied to many different people, such as the principle of self-actualisation or the trait of extraversion. Idiographic psychology is an attempt to understand the unique aspects of a particular individual.

The study of personality has a broad and varied history in psychology, with an abundance of theoretical traditions. The major theories include dispositional (trait) perspective, psychodynamic, humanistic, biological, behaviourist, evolutionary, and social learning perspective. Many researchers and psychologists do not explicitly identify themselves with a certain perspective and instead take an eclectic approach. Research in this area is empirically driven – such as dimensional models, based on multivariate statistics such as factor analysis – or emphasizes theory development, such as that of the psychodynamic theory. There is also a substantial emphasis on the applied field of personality testing. In psychological education and training, the study of the nature of personality and its psychological development is usually reviewed as a prerequisite to courses in abnormal psychology or clinical psychology.

Philosophical Assumptions

Many of the ideas conceptualised by historical and modern personality theorists stem from the basic philosophical assumptions they hold. The study of personality is not a purely empirical discipline, as it brings in elements of art, science, and philosophy to draw general conclusions. The following five categories are some of the most fundamental philosophical assumptions on which theorists disagree:

AssumptionOutline
Freedom versus DeterminismThis is the question of whether humans have control over their own behaviour and understand the motives behind it, or if their behaviour is causally determined by forces beyond their control. Behaviour is categorised as being either unconscious, environmental or biological by various theories.
Heredity (Nature) versus Environment (Nurture)Personality is thought to be determined largely either by genetics and biology, or by environment and experiences. Contemporary research suggests that most personality traits are based on the joint influence of genetics and environment. One of the forerunners in this arena is C. Robert Cloninger, who pioneered the Temperament and Character model.
Uniqueness versus UniversalityThis question discusses the extent of each human’s individuality (uniqueness) or similarity in nature (universality). Gordon Allport, Abraham Maslow, and Carl Rogers were all advocates of the uniqueness of individuals. Behaviourists and cognitive theorists, in contrast, emphasize the importance of universal principles, such as reinforcement and self-efficacy.
Active versus ReactiveThis question explores whether humans primarily act through individual initiative (active) or through outside stimuli. Traditional behavioural theorists typically believed that humans are passively shaped by their environments, whereas humanistic and cognitive theorists believe that humans play a more active role. Most modern theorists agree that both are important, with aggregate behaviour being primarily determined by traits and situational factors being the primary predictor of behaviour in the short term.
Optimistic versus PessimisticPersonality theories differ with regard to whether humans are integral in the changing of their own personalities. Theories that place a great deal of emphasis on learning are often more optimistic than those that do not.

Personality Theories

Type Theories

Personality type refers to the psychological classification of people into different classes. Personality types are distinguished from personality traits, which come in different degrees. There are many theories of personality, but each one contains several and sometimes many sub theories. A “theory of personality” constructed by any given psychologist will contain multiple relating theories or sub theories often expanding as more psychologists explore the theory. For example, according to type theories, there are two types of people, introverts and extroverts. According to trait theories, introversion and extroversion are part of a continuous dimension with many people in the middle. The idea of psychological types originated in the theoretical work of Carl Jung, specifically in his 1921 book Psychologische Typen (Psychological Types) and William Marston.

Building on the writings and observations of Jung during World War II, Isabel Briggs Myers and her mother, Katharine C. Briggs, delineated personality types by constructing the Myers-Briggs Type Indicator. This model was later used by David Keirsey with a different understanding from Jung, Briggs and Myers. In the former Soviet Union, Lithuanian Aušra Augustinavičiūtė independently derived a model of personality type from Jung’s called socionics. Later on many other tests were developed on this model e.g. Golden, PTI-Pro and JTI.

Theories could also be considered an “approach” to personality or psychology and is generally referred to as a model. The model is an older and more theoretical approach to personality, accepting extroversion and introversion as basic psychological orientations in connection with two pairs of psychological functions:

  • Perceiving functions: sensing and intuition (trust in concrete, sensory-oriented facts vs. trust in abstract concepts and imagined possibilities).
  • Judging functions: thinking and feeling (basing decisions primarily on logic vs. deciding based on emotion).

Briggs and Myers also added another personality dimension to their type indicator to measure whether a person prefers to use a judging or perceiving function when interacting with the external world. Therefore, they included questions designed to indicate whether someone wishes to come to conclusions (judgement) or to keep options open (perception).

This personality typology has some aspects of a trait theory: it explains people’s behavior in terms of opposite fixed characteristics. In these more traditional models, the sensing/intuition preference is considered the most basic, dividing people into “N” (intuitive) or “S” (sensing) personality types. An “N” is further assumed to be guided either by thinking or feeling and divided into the “NT” (scientist, engineer) or “NF” (author, humanitarian) temperament. An “S”, in contrast, is assumed to be guided more by the judgment/perception axis and thus divided into the “SJ” (guardian, traditionalist) or “SP” (performer, artisan) temperament. These four are considered basic, with the other two factors in each case (including always extraversion/introversion) less important. Critics of this traditional view have observed that the types can be quite strongly stereotyped by professions (although neither Myers nor Keirsey engaged in such stereotyping in their type descriptions), and thus may arise more from the need to categorise people for purposes of guiding their career choice. This among other objections led to the emergence of the five-factor view, which is less concerned with behaviour under work conditions and more concerned with behaviour in personal and emotional circumstances (The MBTI is not designed to measure the “work self”, but rather what Myers and McCaulley called the “shoes-off self.”).

Type A and Type B personality theory: During the 1950s, Meyer Friedman and his co-workers defined what they called Type A and Type B behaviour patterns. They theorised that intense, hard-driving Type A personalities had a higher risk of coronary disease because they are “stress junkies.” Type B people, on the other hand, tended to be relaxed, less competitive, and lower in risk. There was also a Type AB mixed profile.

John L. Holland’s RIASEC vocational model, commonly referred to as the Holland Codes, stipulates that six personality types lead people to choose their career paths. In this circumplex model, the six types are represented as a hexagon, with adjacent types more closely related than those more distant. The model is widely used in vocational counselling.

Eduard Spranger’s personality-model, consisting of six (or, by some revisions, 6 +1) basic types of value attitudes, described in his book Types of Men (Lebensformen; Halle (Saale): Niemeyer, 1914; English translation by P.J.W. Pigors – New York: G. E. Stechert Company, 1928).

The Enneagram of Personality, a model of human personality which is principally used as a typology of nine interconnected personality types. It has been criticised as being subject to interpretation, making it difficult to test or validate scientifically.

Perhaps the most ancient attempt at personality psychology is the personality typology outlined by the Indian Buddhist Abhidharma schools. This typology mostly focuses on negative personal traits (greed, hatred, and delusion) and the corresponding positive meditation practices used to counter those traits.

Psychoanalytical Theories

Psychoanalytic theories explain human behaviour in terms of the interaction of various components of personality. Sigmund Freud was the founder of this school of thought. He drew on the physics of his day (thermodynamics) to coin the term psychodynamics. Based on the idea of converting heat into mechanical energy, Freud proposed psychic energy could be converted into behaviour. His theory places central importance on dynamic, unconscious psychological conflicts.

Freud divides human personality into three significant components: the id, ego and super-ego. The id acts according to the pleasure principle, demanding immediate gratification of its needs regardless of external environment; the ego then must emerge in order to realistically meet the wishes and demands of the id in accordance with the outside world, adhering to the reality principle. Finally, the superego (conscience) inculcates moral judgment and societal rules upon the ego, thus forcing the demands of the id to be met not only realistically but morally. The superego is the last function of the personality to develop, and is the embodiment of parental/social ideals established during childhood. According to Freud, personality is based on the dynamic interactions of these three components.

The channelling and release of sexual (libidal) and aggressive energies, which ensues from the “Eros” (sex; instinctual self-preservation) and “Thanatos” (death; instinctual self-annihilation) drives respectively, are major components of his theory. It is important to note that Freud’s broad understanding of sexuality included all kinds of pleasurable feelings experienced by the human body.

Freud proposed five psychosexual stages of personality development. He believed adult personality is dependent upon early childhood experiences and largely determined by age five. Fixations that develop during the infantile stage contribute to adult personality and behaviour.

One of Sigmund Freud’s earlier associates, Alfred Adler, agreed with Freud that early childhood experiences are important to development, and believed birth order may influence personality development. Adler believed that the oldest child was the individual who would set high achievement goals in order to gain attention lost when the younger siblings were born. He believed the middle children were competitive and ambitious. He reasoned that this behaviour was motivated by the idea of surpassing the firstborn’s achievements. He added, however, that the middle children were often not as concerned about the glory attributed to their behaviour. He also believed the youngest would be more dependent and sociable. Adler finished by surmising that an only child loves being the centre of attention and matures quickly but in the end fails to become independent.

Heinz Kohut thought similarly to Freud’s idea of transference. He used narcissism as a model of how people develop their sense of self. Narcissism is the exaggerated sense of self in which one is believed to exist in order to protect one’s low self-esteem and sense of worthlessness. Kohut had a significant impact on the field by extending Freud’s theory of narcissism and introducing what he called the ‘self-object transferences’ of mirroring and idealisation. In other words, children need to idealize and emotionally “sink into” and identify with the idealised competence of admired figures such as parents or older siblings. They also need to have their self-worth mirrored by these people. Such experiences allow them to thereby learn the self-soothing and other skills that are necessary for the development of a healthy sense of self.

Another important figure in the world of personality theory is Karen Horney. She is credited with the development of “Feminist Psychology”. She disagrees with Freud on some key points, one being that women’s personalities are not just a function of “Penis Envy”, but that girl children have separate and different psychic lives unrelated to how they feel about their fathers or primary male role models. She talks about three basic Neurotic needs “Basic Anxiety”, “Basic Hostility” and “Basic Evil”. She posits that to any anxiety an individual experiences they would have one of three approaches, moving toward people, moving away from people or moving against people. It is these three that give us varying personality types and characteristics. She also places a high premium on concepts like Overvaluation of Love and romantic partners.

Behaviourist Theories

Behaviourists explain personality in terms of the effects external stimuli have on behaviour. The approaches used to evaluate the behavioural aspect of personality are known as behavioural theories or learning-conditioning theories. These approaches were a radical shift away from Freudian philosophy. One of the major tenets of this concentration of personality psychology is a strong emphasis on scientific thinking and experimentation. This school of thought was developed by B.F. Skinner who put forth a model which emphasized the mutual interaction of the person or “the organism” with its environment. Skinner believed children do bad things because the behaviour obtains attention that serves as a reinforcer. For example: a child cries because the child’s crying in the past has led to attention. These are the response, and consequences. The response is the child crying, and the attention that child gets is the reinforcing consequence. According to this theory, people’s behaviour is formed by processes such as operant conditioning. Skinner put forward a “three term contingency model” which helped promote analysis of behaviour based on the “Stimulus – Response – Consequence Model” in which the critical question is: “Under which circumstances or antecedent ‘stimuli’ does the organism engage in a particular behavior or ‘response’, which in turn produces a particular ‘consequence’?”

Richard Herrnstein extended this theory by accounting for attitudes and traits. An attitude develops as the response strength (the tendency to respond) in the presences of a group of stimuli become stable. Rather than describing conditionable traits in non-behavioural language, response strength in a given situation accounts for the environmental portion. Herrstein also saw traits as having a large genetic or biological component, as do most modern behaviourists.

Ivan Pavlov is another notable influence. He is well known for his classical conditioning experiments involving dogs, which led him to discover the foundation of behaviourism.

Social Cognitive Theories

In cognitive theory, behaviour is explained as guided by cognitions (e.g. expectations) about the world, especially those about other people. Cognitive theories are theories of personality that emphasize cognitive processes, such as thinking and judging.

Albert Bandura, a social learning theorist suggested the forces of memory and emotions worked in conjunction with environmental influences. Bandura was known mostly for his “Bobo doll experiment”. During these experiments, Bandura video taped a college student kicking and verbally abusing a bobo doll. He then showed this video to a class of kindergarten children who were getting ready to go out to play. When they entered the play room, they saw bobo dolls, and some hammers. The people observing these children at play saw a group of children beating the doll. He called this study and his findings observational learning, or modelling.

Early examples of approaches to cognitive style are listed by Baron (1982). These include Witkin’s (1965) work on field dependency, Gardner’s (1953) discovering people had consistent preference for the number of categories they used to categorise heterogeneous objects, and Block and Petersen’s (1955) work on confidence in line discrimination judgments. Baron relates early development of cognitive approaches of personality to ego psychology. More central to this field have been:

  • Attributional style theory dealing with different ways in which people explain events in their lives. This approach builds upon locus of control, but extends it by stating we also need to consider whether people attribute to stable causes or variable causes, and to global causes or specific causes.

Various scales have been developed to assess both attributional style and locus of control. Locus of control scales include those used by Rotter and later by Duttweiler, the Nowicki and Strickland (1973) Locus of Control Scale for Children and various locus of control scales specifically in the health domain, most famously that of Kenneth Wallston and his colleagues, The Multidimensional Health Locus of Control Scale. Attributional style has been assessed by the Attributional Style Questionnaire, the Expanded Attributional Style Questionnaire, the Attributions Questionnaire, the Real Events Attributional Style Questionnaire and the Attributional Style Assessment Test.

  • Achievement style theory focuses upon identification of an individual’s Locus of Control tendency, such as by Rotter’s evaluations, and was found by Cassandra Bolyard Whyte to provide valuable information for improving academic performance of students. Individuals with internal control tendencies are likely to persist to better academic performance levels, presenting an achievement personality, according to Cassandra B. Whyte.

Recognition that the tendency to believe that hard work and persistence often results in attainment of life and academic goals has influenced formal educational and counselling efforts with students of various ages and in various settings since the 1970s research about achievement. Counselling aimed toward encouraging individuals to design ambitious goals and work toward them, with recognition that there are external factors that may impact, often results in the incorporation of a more positive achievement style by students and employees, whatever the setting, to include higher education, workplace, or justice programming.

Walter Mischel (1999) has also defended a cognitive approach to personality. His work refers to “Cognitive Affective Units”, and considers factors such as encoding of stimuli, affect, goal-setting, and self-regulatory beliefs. The term “Cognitive Affective Units” shows how his approach considers affect as well as cognition.

Cognitive-Experiential Self-Theory (CEST) is another cognitive personality theory. Developed by Seymour Epstein, CEST argues that humans operate by way of two independent information processing systems: experiential system and rational system. The experiential system is fast and emotion-driven. The rational system is slow and logic-driven. These two systems interact to determine our goals, thoughts, and behaviolr.

Personal construct psychology (PCP) is a theory of personality developed by the American psychologist George Kelly in the 1950s. Kelly’s fundamental view of personality was that people are like naïve scientists who see the world through a particular lens, based on their uniquely organised systems of construction, which they use to anticipate events. But because people are naïve scientists, they sometimes employ systems for construing the world that are distorted by idiosyncratic experiences not applicable to their current social situation. A system of construction that chronically fails to characterise and/or predict events, and is not appropriately revised to comprehend and predict one’s changing social world, is considered to underlie psychopathology (or mental illness). From the theory, Kelly derived a psychotherapy approach and also a technique called The Repertory Grid Interview that helped his patients to uncover their own “constructs” with minimal intervention or interpretation by the therapist. The repertory grid was later adapted for various uses within organisations, including decision-making and interpretation of other people’s world-views.

Humanistic Theories

Humanistic psychology emphasizes that people have free will and that this plays an active role in determining how they behave. Accordingly, humanistic psychology focuses on subjective experiences of persons as opposed to forced, definitive factors that determine behaviour. Abraham Maslow and Carl Rogers were proponents of this view, which is based on the “phenomenal field” theory of Combs and Snygg (1949). Rogers and Maslow were among a group of psychologists that worked together for a decade to produce the Journal of Humanistic Psychology. This journal was primarily focused on viewing individuals as a whole, rather than focusing solely on separate traits and processes within the individual.

Robert W. White wrote the book The Abnormal Personality that became a standard text on abnormal psychology. He also investigated the human need to strive for positive goals like competence and influence, to counterbalance the emphasis of Freud on the pathological elements of personality development.

Maslow spent much of his time studying what he called “self-actualizing persons”, those who are “fulfilling themselves and doing the best they are capable of doing”. Maslow believes all who are interested in growth move towards self-actualizing (growth, happiness, satisfaction) views. Many of these people demonstrate a trend in dimensions of their personalities. Characteristics of self-actualisers according to Maslow include the four key dimensions:

DimensionOutline
Awarenessmaintaining constant enjoyment and awe of life. These individuals often experienced a “peak experience”. He defined a peak experience as an “intensification of any experience to the degree there is a loss or transcendence of self”. A peak experience is one in which an individual perceives an expansion of themselves, and detects a unity and meaningfulness in life. Intense concentration on an activity one is involved in, such as running a marathon, may invoke a peak experience.
Reality and Problem CentredHaving a tendency to be concerned with “problems” in surroundings.
Acceptance/SpontaneityAccepting surroundings and what cannot be changed.
Unhostile Sense of Humour/DemocraticDo not take kindly to joking about others, which can be viewed as offensive. They have friends of all backgrounds and religions and hold very close friendships.

Maslow and Rogers emphasized a view of the person as an active, creative, experiencing human being who lives in the present and subjectively responds to current perceptions, relationships, and encounters. They disagree with the dark, pessimistic outlook of those in the Freudian psychoanalysis ranks, but rather view humanistic theories as positive and optimistic proposals which stress the tendency of the human personality toward growth and self-actualization. This progressing self will remain the centre of its constantly changing world; a world that will help mould the self but not necessarily confine it. Rather, the self has opportunity for maturation based on its encounters with this world. This understanding attempts to reduce the acceptance of hopeless redundancy. Humanistic therapy typically relies on the client for information of the past and its effect on the present, therefore the client dictates the type of guidance the therapist may initiate. This allows for an individualised approach to therapy. Rogers found patients differ in how they respond to other people. Rogers tried to model a particular approach to therapy – he stressed the reflective or empathetic response. This response type takes the client’s viewpoint and reflects back their feeling and the context for it. An example of a reflective response would be, “It seems you are feeling anxious about your upcoming marriage”. This response type seeks to clarify the therapist’s understanding while also encouraging the client to think more deeply and seek to fully understand the feelings they have expressed.

Biopsychological Theories

Biology plays a very important role in the development of personality. The study of the biological level in personality psychology focuses primarily on identifying the role of genetic determinants and how they mould individual personalities. Some of the earliest thinking about possible biological bases of personality grew out of the case of Phineas Gage. In an 1848 accident, a large iron rod was driven through Gage’s head, and his personality apparently changed as a result, although descriptions of these psychological changes are usually exaggerated.

In general, patients with brain damage have been difficult to find and study. In the 1990s, researchers began to use electroencephalography (EEG), positron emission tomography (PET), and more recently functional magnetic resonance imaging (fMRI), which is now the most widely used imaging technique to help localise personality traits in the brain.

Genetic Basis of Personality

Ever since the Human Genome Project allowed for a much more in depth comprehension of genetics, there has been an ongoing controversy involving heritability, personality traits, and environmental vs. genetic influence on personality. The human genome is known to play a role in the development of personality.

Previously, genetic personality studies focused on specific genes correlating to specific personality traits. Today’s view of the gene-personality relationship focuses primarily on the activation and expression of genes related to personality and forms part of what is referred to as behavioural genetics. Genes provide numerous options for varying cells to be expressed; however, the environment determines which of these are activated. Many studies have noted this relationship in varying ways in which our bodies can develop, but the interaction between genes and the shaping of our minds and personality is also relevant to this biological relationship.

DNA-environment interactions are important in the development of personality because this relationship determines what part of the DNA code is actually made into proteins that will become part of an individual. While different choices are made available by the genome, in the end, the environment is the ultimate determinant of what becomes activated. Small changes in DNA in individuals are what leads to the uniqueness of every person as well as differences in looks, abilities, brain functioning, and all the factors that culminate to develop a cohesive personality.

Cattell and Eysenck have proposed that genetics have a powerful influence on personality. A large part of the evidence collected linking genetics and the environment to personality have come from twin studies. This “twin method” compares levels of similarity in personality using genetically identical twins. One of the first of these twin studies measured 800 pairs of twins, studied numerous personality traits, and determined that identical twins are most similar in their general abilities. Personality similarities were found to be less related for self-concepts, goals, and interests.

Twin studies have also been important in the creation of the five factor personality model: neuroticism, extraversion, openness, agreeableness, and conscientiousness. Neuroticism and extraversion are the two most widely studied traits. Individuals scoring high in trait extraversion more often display characteristics such as impulsiveness, sociability, and activeness. Individuals scoring high in trait neuroticism are more likely to be moody, anxious, or irritable. Identical twins, however, have higher correlations in personality traits than fraternal twins. One study measuring genetic influence on twins in five different countries found that the correlations for identical twins were .50, while for fraternal they were about .20. It is suggested that heredity and environment interact to determine one’s personality.

Evolutionary Theory

Charles Darwin is the founder of the theory of the evolution of the species. The evolutionary approach to personality psychology is based on this theory. This theory examines how individual personality differences are based on natural selection. Through natural selection organisms change over time through adaptation and selection. Traits are developed and certain genes come into expression based on an organism’s environment and how these traits aid in an organism’s survival and reproduction.

Polymorphisms, such as gender and blood type, are forms of diversity which evolve to benefit a species as a whole. The theory of evolution has wide-ranging implications on personality psychology. Personality viewed through the lens of evolutionary psychology places a great deal of emphasis on specific traits that are most likely to aid in survival and reproduction, such as conscientiousness, sociability, emotional stability, and dominance. The social aspects of personality can be seen through an evolutionary perspective. Specific character traits develop and are selected for because they play an important and complex role in the social hierarchy of organisms. Such characteristics of this social hierarchy include the sharing of important resources, family and mating interactions, and the harm or help organisms can bestow upon one another.

Drive Theories

In the 1930s, John Dollard and Neal Elgar Miller met at Yale University, and began an attempt to integrate drives, into a theory of personality, basing themselves on the work of Clark Hull. They began with the premise that personality could be equated with the habitual responses exhibited by an individual – their habits. From there, they determined that these habitual responses were built on secondary, or acquired drives.

Secondary drives are internal needs directing the behaviour of an individual that results from learning. Acquired drives are learned, by and large in the manner described by classical conditioning. When we are in a certain environment and experience a strong response to a stimulus, we internalise cues from the said environment. When we find ourselves in an environment with similar cues, we begin to act in anticipation of a similar stimulus. Thus, we are likely to experience anxiety in an environment with cues similar to one where we have experienced pain or fear – such as the dentist’s office.

Secondary drives are built on primary drives, which are biologically driven, and motivate us to act with no prior learning process – such as hunger, thirst or the need for sexual activity. However, secondary drives are thought to represent more specific elaborations of primary drives, behind which the functions of the original primary drive continue to exist. Thus, the primary drives of fear and pain exist behind the acquired drive of anxiety. Secondary drives can be based on multiple primary drives and even in other secondary drives. This is said to give them strength and persistence. Examples include the need for money, which was conceptualised as arising from multiple primary drives such as the drive for food and warmth, as well as from secondary drives such as imitativeness (the drive to do as others do) and anxiety.

Secondary drives vary based on the social conditions under which they were learned – such as culture. Dollard and Miller used the example of food, stating that the primary drive of hunger manifested itself behind the learned secondary drive of an appetite for a specific type of food, which was dependent on the culture of the individual.

Secondary drives are also explicitly social, representing a manner in which we convey our primary drives to others. Indeed, many primary drives are actively repressed by society (such as the sexual drive). Dollard and Miller believed that the acquisition of secondary drives was essential to childhood development. As children develop, they learn not to act on their primary drives, such as hunger but acquire secondary drives through reinforcement. Friedman and Schustack describe an example of such developmental changes, stating that if an infant engaging in an active orientation towards others brings about the fulfilment of primary drives, such as being fed or having their diaper changed, they will develop a secondary drive to pursue similar interactions with others – perhaps leading to an individual being more gregarious. Dollard and Miller’s belief in the importance of acquired drives led them to reconceive Sigmund Freud’s theory of psychosexual development. They found themselves to be in agreement with the timing Freud used but believed that these periods corresponded to the successful learning of certain secondary drives.

Dollard and Miller gave many examples of how secondary drives impact our habitual responses – and by extension our personalities, including anger, social conformity, imitativeness or anxiety, to name a few. In the case of anxiety, Dollard and Miller note that people who generalise the situation in which they experience the anxiety drive will experience anxiety far more than they should. These people are often anxious all the time, and anxiety becomes part of their personality. This example shows how drive theory can have ties with other theories of personality – many of them look at the trait of neuroticism or emotional stability in people, which is strongly linked to anxiety.

Personality Tests

There are two major types of personality tests, projective and objective.

Projective tests assume personality is primarily unconscious and assess individuals by how they respond to an ambiguous stimulus, such as an ink blot. Projective tests have been in use for about 60 years and continue to be used today. Examples of such tests include the Rorschach test and the Thematic Apperception Test.

The Rorschach Test involves showing an individual a series of note cards with ambiguous ink blots on them. The individual being tested is asked to provide interpretations of the blots on the cards by stating everything that the ink blot may resemble based on their personal interpretation. The therapist then analyses their responses. Rules for scoring the test have been covered in manuals that cover a wide variety of characteristics such as content, originality of response, location of “perceived images” and several other factors. Using these specific scoring methods, the therapist will then attempt to relate test responses to attributes of the individual’s personality and their unique characteristics. The idea is that unconscious needs will come out in the person’s response, e.g. an aggressive person may see images of destruction.

The Thematic Apperception Test (TAT) involves presenting individuals with vague pictures/scenes and asking them to tell a story based on what they see. Common examples of these “scenes” include images that may suggest family relationships or specific situations, such as a father and son or a man and a woman in a bedroom. Responses are analysed for common themes. Responses unique to an individual are theoretically meant to indicate underlying thoughts, processes, and potentially conflicts present within the individual. Responses are believed to be directly linked to unconscious motives. There is very little empirical evidence available to support these methods.

Objective tests assume personality is consciously accessible and that it can be measured by self-report questionnaires. Research on psychological assessment has generally found objective tests to be more valid and reliable than projective tests. Critics have pointed to the Forer effect to suggest some of these appear to be more accurate and discriminating than they really are. Issues with these tests include false reporting because there is no way to tell if an individual is answering a question honestly or accurately.

The Myers-Briggs Type Indicator (also known as the MBTI) is self-reporting questionnaire based on Carl Jung’s Type theory. However, the MBTI modified Jung’s theory into their own by disregarding certain processes held in the unconscious mind and the impact these have on personality.

Personality Theory Assessment Criteria

  • Verifiability – the theory should be formulated in such a way that the concepts, suggestions and hypotheses involved in it are defined clearly and unambiguously, and logically related to each other.
  • Heuristic value – to what extent the theory stimulates scientists to conduct further research.
  • Internal consistency – the theory should be free from internal contradictions.
  • Economy – the fewer concepts and assumptions required by the theory to explain any phenomenon, the better it is Hjelle, Larry (1992). Personality Theories: Basic Assumptions, Research, and Applications.

Psychology has traditionally defined personality through its behavioural patterns, and more recently with neuroscientific studies of the brain. In recent years, some psychologists have turned to the study of inner experiences for insight into personality as well as individuality. Inner experiences are the thoughts and feelings to an immediate phenomenon. Another term used to define inner experiences is qualia. Being able to understand inner experiences assists in understanding how humans behave, act, and respond. Defining personality using inner experiences has been expanding due to the fact that solely relying on behavioural principles to explain one’s character may seem incomplete. Behavioural methods allow the subject to be observed by an observer, whereas with inner experiences the subject is its own observer.

Methods Measuring Inner Experience

Descriptive Experience Sampling (DES)Developed by psychologist Russel Hurlburt. This is an idiographic method that is used to help examine inner experiences. This method relies on an introspective technique that allows an individual’s inner experiences and characteristics to be described and measured. A beep notifies the subject to record their experience at that exact moment and 24 hours later an interview is given based on all the experiences recorded. DES has been used in subjects that have been diagnosed with schizophrenia and depression. It has also been crucial to studying the inner experiences of those who have been diagnosed with common psychiatric diseases.
Articulated Thoughts in Stimulated Situations (ATSS)ATSS is a paradigm which was created as an alternative to the TA (think aloud) method. This method assumes that people have continuous internal dialogues that can be naturally attended to. ATSS also assesses a person’s inner thoughts as they verbalise their cognitions. In this procedure, subjects listen to a scenario via a video or audio player and are asked to imagine that they are in that specific situation. Later, they are asked to articulate their thoughts as they occur in reaction to the playing scenario. This method is useful in studying emotional experience given that the scenarios used can influence specific emotions. Most importantly, the method has contributed to the study of personality. In a study conducted by Rayburn and Davison (2002), subjects’ thoughts and empathy toward anti-gay hate crimes were evaluated. The researchers found that participants showed more aggressive intentions towards the offender in scenarios which mimicked hate crimes.
Experimental MethodThis method is an experimental paradigm used to study human experiences involved in the studies of sensation and perception, learning and memory, motivation, and biological psychology. The experimental psychologist usually deals with intact organisms although studies are often conducted with organisms modified by surgery, radiation, drug treatment, or long-standing deprivations of various kinds or with organisms that naturally present organic abnormalities or emotional disorders. Economists and psychologists have developed a variety of experimental methodologies to elicit and assess individual attitudes where each emotion differs for each individual. The results are then gathered and quantified to conclude if specific experiences have any common factors. This method is used to seek clarity of the experience and remove any biases to help understand the meaning behind the experience to see if it can be generalised.

What is Alexithymia?

Introduction

Alexithymia is a personality trait characterised by the subclinical inability to identify and describe emotions experienced by one’s self.

The core characteristic of alexithymia is marked dysfunction in emotional awareness, social attachment, and interpersonal relation. Furthermore, people with high levels of alexithymia can have difficulty distinguishing and appreciating the emotions of others, which is thought to lead to non-empathic and ineffective emotional responses.

High levels of alexithymia occur in approximately 10% of the population and can occur with a number of psychiatric conditions as well as any neurodevelopmental disorder. Difficulty with recognising and talking about their emotions appears at subclinical levels in men who conform to western cultural notions of masculinity (such as thinking that sadness is a feminine emotion). This is called normative male alexithymia by some researchers. However, both alexithymia itself and its association with traditionally masculine norms are consistent across genders.

Lexicology

The term alexithymia was coined by psychotherapists John Case Nemiah and Peter Sifneos in 1973. The word comes from Greek: ἀ- (a-, ‘not’, privative prefix, alpha privative) + λέξις (léxis, ‘words’) + θῡμός (thȳmós, ‘heart’ or ’emotions’ or ‘seat of speech’) (cf. dyslexia), literally meaning “no words for emotions”.

Another etymology: Greek: Αλεξιθυμία ἀλέξω (to ward off) + θῡμός. Means to push away emotions, feelings

Nonmedical terms describing similar conditions include emotionless and impassive. People with the condition are called alexithymics or alexithymiacs.

Classification

Alexithymia is considered to be a personality trait that places affected individuals at risk for other medical and psychiatric disorders while reducing the likelihood that these individuals will respond to conventional treatments for the other conditions. Alexithymia is not classified as a mental disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. It is a dimensional personality trait that varies in intensity from person to person. A person’s alexithymia score can be measured with questionnaires such as the Toronto Alexithymia Scale (TAS-20), the Perth Alexithymia Questionnaire (PAQ), the Bermond-Vorst Alexithymia Questionnaire (BVAQ), the Levels of Emotional Awareness Scale (LEAS), the Online Alexithymia Questionnaire (OAQ-G2), the Toronto Structured Interview for Alexithymia (TSIA), or the Observer Alexithymia Scale (OAS). It is distinct from the psychiatric personality disorders, such as antisocial personality disorder.

Traditionally, alexithymia has been conceptually defined by four components:

  • Difficulty identifying feelings (DIF).
  • Difficulty describing feelings to other people (DDF).
  • A stimulus-bound, externally oriented thinking style (EOT).
  • Constricted imaginal processes (IMP),

However, there is some ongoing disagreement in the field about the definition of alexithymia. When measured in empirical studies, constricted imaginal processes are often found not to statistically cohere with the other components of alexithymia. Such findings have led to debate in the field about whether IMP is indeed a component of alexithymia. For example, in 2017, Preece and colleagues introduced the attention-appraisal model of alexithymia, where they suggested that IMP be removed from the definition and that alexithymia be conceptually composed only of DIF, DDF, and EOT, as each of these three are specific to deficits in emotion processing. In practice, since the constricted imaginal processes items were removed from earlier versions of the TAS-20 in the 1990s, the most used alexithymia assessment tools (and consequently most alexithymia research studies) have only assessed the construct in terms of DIF, DDF, and EOT.

Studies (using measures of alexithymia assessing DIF, DDF, and EOT) have reported that the prevalence rate of high alexithymia is less than 10% of the population. A less common finding suggests that there may be a higher prevalence of alexithymia amongst males than females, which may be accounted for by difficulties some males have with “describing feelings”, but not by difficulties in “identifying feelings” in which males and females show similar abilities.

Psychologist R. Michael Bagby and psychiatrist Graeme J. Taylor have argued that the alexithymia construct is inversely related to the concepts of psychological mindedness and emotional intelligence and there is “strong empirical support for alexithymia being a stable personality trait rather than just a consequence of psychological distress”.

Signs and Symptoms

Typical deficiencies may include problems identifying, processing, describing, and working with one’s own feelings, often marked by a lack of understanding of the feelings of others; difficulty distinguishing between feelings and the bodily sensations of emotional arousal; confusion of physical sensations often associated with emotions; few dreams or fantasies due to restricted imagination; and concrete, realistic, logical thinking, often to the exclusion of emotional responses to problems. Those who have alexithymia also report very logical and realistic dreams, such as going to the store or eating a meal. Clinical experience suggests it is the structural features of dreams more than the ability to recall them that best characterises alexithymia.

Some alexithymic individuals may appear to contradict the above-mentioned characteristics because they can experience chronic dysphoria or manifest outbursts of crying or rage. However, questioning usually reveals that they are quite incapable of describing their feelings or appear confused by questions inquiring about specifics of feelings.

According to Henry Krystal, individuals exhibiting alexithymia think in an operative way and may appear to be super-adjusted to reality. In psychotherapy, however, a cognitive disturbance becomes apparent as patients tend to recount trivial, chronologically ordered actions, reactions, and events of daily life with monotonous detail. In general, these individuals can, but not always, seem oriented toward things and even treat themselves as robots. These problems seriously limit their responsiveness to psychoanalytic psychotherapy; psychosomatic illness or substance abuse is frequently exacerbated should these individuals enter psychotherapy.

A common misconception about alexithymia is that affected individuals are totally unable to express emotions verbally and that they may even fail to acknowledge that they experience emotions. Even before coining the term, Sifneos (1967) noted patients often mentioned things like anxiety or depression. The distinguishing factor was their inability to elaborate beyond a few limited adjectives such as “happy” or “unhappy” when describing these feelings. The core issue is that people with alexithymia have poorly differentiated emotions limiting their ability to distinguish and describe them to others. This contributes to the sense of emotional detachment from themselves and difficulty connecting with others, making alexithymia negatively associated with life satisfaction even when depression and other confounding factors are controlled for.

Associated Conditions

Alexithymia frequently co-occurs with other disorders. Research indicates that alexithymia overlaps with autism spectrum disorders (ASD). In a 2004 study using the TAS-20, 85% of the adults with ASD fell into the “impaired” category and almost half fell into the “severely impaired” category; in contrast, among the adult control population only 17% were “impaired”, none “severely impaired”. Fitzgerald & Bellgrove pointed out that, “Like alexithymia, Asperger’s syndrome is also characterised by core disturbances in speech and language and social relationships”. Hill & Berthoz agreed with Fitzgerald & Bellgrove (2006) and in response stated that “there is some form of overlap between alexithymia and ASDs”. They also pointed to studies that revealed impaired theory of mind skill in alexithymia, neuroanatomical evidence pointing to a shared aetiology and similar social skills deficits. The exact nature of the overlap is uncertain. Alexithymic traits in ASD may be linked to clinical depression or anxiety; the mediating factors are unknown and it is possible that alexithymia predisposes to anxiety. On the other hand, while the total alexithymia score as well as the difficulty in identifying feelings and externally oriented thinking factors are found to be significantly associated with ADHD, and while the total alexithymia score, the difficulty in identifying feelings, and the difficulty in describing feelings factors are also significantly associated with symptoms of hyperactivity/impulsivity, there is no significant relationship between alexithymia and inattentiveness symptom.

There are many more psychiatric disorders that overlap with alexithymia. One study found that 41% of US veterans of the Vietnam War with post-traumatic stress disorder (PTSD) were alexithymic. Another study found higher levels of alexithymia among Holocaust survivors with PTSD compared to those without. Higher levels of alexithymia among mothers with interpersonal violence-related PTSD were found in one study to have proportionally less caregiving sensitivity. This latter study suggested that when treating adult PTSD patients who are parents, alexithymia should be assessed and addressed also with attention to the parent-child relationship and the child’s social-emotional development.

Single study prevalence findings for other disorders include 63% in anorexia nervosa, 56% in bulimia, 45% to 50% in major depressive disorder, 34% in panic disorder, 28% in social phobia, and 50% in substance abusers. Alexithymia is also exhibited by a large proportion of individuals with acquired brain injuries such as stroke or traumatic brain injury.

Alexithymia is correlated with certain personality disorders, particularly schizoid, avoidant, dependent and schizotypal, substance use disorders, some anxiety disorders and sexual disorders as well as certain physical illnesses, such as hypertension, inflammatory bowel disease and functional dyspepsia. Alexithymia is further linked with disorders such as migraine headaches, lower back pain, irritable bowel syndrome, asthma, nausea, allergies and fibromyalgia.

An inability to modulate emotions is a possibility in explaining why some people with alexithymia are prone to discharge tension arising from unpleasant emotional states through impulsive acts or compulsive behaviours such as binge eating, substance abuse, perverse sexual behaviour or anorexia nervosa. The failure to regulate emotions cognitively might result in prolonged elevations of the autonomic nervous system (ANS) and neuroendocrine systems, which can lead to somatic diseases. People with alexithymia also show a limited ability to experience positive emotions leading Krystal (1988) and Sifneos (1987) to describe many of these individuals as anhedonic.

Alexisomia is a clinical concept that refers to the difficulty in the awareness and expression of somatic, or bodily, sensations. The concept was first proposed in 1979 by Dr. Yujiro Ikemi when he observed characteristics of both alexithymia and alexisomia in patients with psychosomatic diseases.

Causes

It is unclear what causes alexithymia, though several theories have been proposed.

Early studies showed evidence that there may be an interhemispheric transfer deficit among people with alexithymia; that is, the emotional information from the right hemisphere of the brain is not being properly transferred to the language regions in the left hemisphere, as can be caused by a decreased corpus callosum, often present in psychiatric patients who have suffered severe childhood abuse. A neuropsychological study in 1997 indicated that alexithymia may be due to a disturbance to the right hemisphere of the brain, which is largely responsible for processing emotions. In addition, another neuropsychological model suggests that alexithymia may be related to a dysfunction of the anterior cingulate cortex. These studies have some shortcomings, however, and the empirical evidence about the neural mechanisms behind alexithymia remains inconclusive.

French psychoanalyst Joyce McDougall objected to the strong focus by clinicians on neurophysiological explanations at the expense of psychological ones for the genesis and operation of alexithymia, and introduced the alternative term “disaffectation” to stand for psychogenic alexithymia. For McDougall, the disaffected individual had at some point “experienced overwhelming emotion that threatened to attack their sense of integrity and identity”, to which they applied psychological defences to pulverise and eject all emotional representations from consciousness. A similar line of interpretation has been taken up using the methods of phenomenology. McDougall has also noted that all infants are born unable to identify, organize, and speak about their emotional experiences (the word infans is from the Latin “not speaking”), and are “by reason of their immaturity inevitably alexithymic”. Based on this fact McDougall proposed in 1985 that the alexithymic part of an adult personality could be “an extremely arrested and infantile psychic structure”. The first language of an infant is nonverbal facial expressions. The parent’s emotional state is important for determining how any child might develop. Neglect or indifference to varying changes in a child’s facial expressions without proper feedback can promote an invalidation of the facial expressions manifested by the child. The parent’s ability to reflect self-awareness to the child is another important factor. If the adult is incapable of recognising and distinguishing emotional expressions in the child, it can influence the child’s capacity to understand emotional expressions.

Molecular genetic research into alexithymia remains minimal, but promising candidates have been identified from studies examining connections between certain genes and alexithymia among those with psychiatric conditions as well as the general population. A study recruiting a test population of Japanese males found higher scores on the Toronto Alexithymia Scale among those with the 5-HTTLPR homozygous long (L) allele. The 5-HTTLPR region on the serotonin transporter gene influences the transcription of the serotonin transporter that removes serotonin from the synaptic cleft, and is well studied for its association with numerous psychiatric disorders. Another study examining the 5-HT1A receptor, a receptor that binds serotonin, found higher levels of alexithymia among those with the G allele of the Rs6295 polymorphism within the HTR1A gene. Also, a study examining alexithymia in subjects with obsessive-compulsive disorder found higher alexithymia levels associated with the Val/Val allele of the Rs4680 polymorphism in the gene that encodes Catechol-O-methyltransferase (COMT), an enzyme which degrades catecholamine neurotransmitters such as dopamine. These links are tentative, and further research will be needed to clarify how these genes relate to the neurological anomalies found in the brains of people with alexithymia.

Although there is evidence for the role of environmental and neurological factors, the role and influence of genetic factors for developing alexithymia is still unclear. A single large scale Danish study suggested that genetic factors contributed noticeably to the development of alexithymia. However, such twin studies are controversial, as they suffer from the “equal environments assumption” and the “heritability” estimates in no way correspond to actual DNA structures. Traumatic brain injury is also implicated in the development of alexithymia, and those with traumatic brain injury are six times more likely to exhibit alexithymia.

In Relationships

Alexithymia can create interpersonal problems because these individuals tend to avoid emotionally close relationships, or if they do form relationships with others they usually position themselves as either dependent, dominant, or impersonal, “such that the relationship remains superficial”. Inadequate “differentiation” between self and others by alexithymic individuals has also been observed. Their difficulty in processing interpersonal connections often develops where the person lacks a romantic partner.

In a study, a large group of alexithymic individuals completed the 64-item Inventory of Interpersonal Problems (IIP-64) which found that “two interpersonal problems are significantly and stably related to alexithymia: cold/distant and non-assertive social functioning. All other IIP-64 subscales were not significantly related to alexithymia.”

Chaotic interpersonal relations have also been observed by Sifneos. Due to the inherent difficulties identifying and describing emotional states in self and others, alexithymia also negatively affects relationship satisfaction between couples.

In a 2008 study alexithymia was found to be correlated with impaired understanding and demonstration of relational affection, and that this impairment contributes to poorer mental health, poorer relational well-being, and lowered relationship quality. Individuals high on the alexithymia spectrum also report less distress at seeing others in pain and behave less altruistically toward others.

Some individuals working for organisations in which control of emotions is the norm might show alexithymic-like behaviour but not be alexithymic. However, over time the lack of self-expressions can become routine and they may find it harder to identify with others.

Treatment

Generally speaking, approaches to treating alexithymia are still in their infancy, with not many proven treatment options available.

In 2002, Kennedy and Franklin found that a skills-based intervention is an effective method for treating alexithymia. Kennedy and Franklin’s treatment plan involved giving the participants a series of questionnaires, psychodynamic therapies, cognitive-behavioural and skills-based therapies, and experiential therapies. After treatment, they found that participants were generally less ambivalent about expressing their emotion feelings and more attentive to their emotional states.

In 2017, based on their attention-appraisal model of alexithymia, Preece and colleagues recommended that alexithymia treatment should target trying to improve the developmental level of people’s emotion schemas and reduce people’s use of experiential avoidance of emotions as an emotion regulation strategy (i.e. the mechanisms hypothesized to underlie alexithymia difficulties in the attention-appraisal model of alexithymia).

In 2018, Löf, Clinton, Kaldo, and Rydén found that mentalisation-based treatment is also an effective method for treating alexithymia. Mentalisation is the ability to understand the mental state of oneself or others that underlies overt behaviour, and mentalisation-based treatment helps patients separate their own thoughts and feelings from those around them. This treatment is relational, and it focuses on gaining a better understanding and use of mentalising skills. The researchers found that all of the patients’ symptoms including alexithymia significantly improved, and the treatment promoted affect tolerance and the ability to think flexibly while expressing intense affect rather than impulsive behaviour.

A significant issue impacting alexithymia treatment is that alexithymia has comorbidity with other disorders. Mendelson’s 1982 study showed that alexithymia frequently presented in people with undiagnosed chronic pain. Participants in Kennedy and Franklin’s study all had anxiety disorders in conjunction with alexithymia, while those in Löf et al. were diagnosed with both alexithymia and borderline personality disorder. All these comorbidity issues complicate treatment because it is difficult to examine people who exclusively have alexithymia.

What is Sadistic Personality Disorder?

Introduction

Sadistic personality disorder (SPD) is a personality disorder involving sadomasochism which appeared in an appendix of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). The later versions of the DSM (DSM-IV, DSM-IV-TR and DSM-5) do not include it.

The words sadism and sadist are derived from Marquis de Sade.

Definition

Sadism involves deriving pleasure through others undergoing discomfort or pain. The opponent-process theory is one way to help explain how an individual may come to not only display, but also enjoy committing sadistic acts. Individuals possessing sadistic personalities tend to display recurrent aggression and cruel behaviour. Sadism can also include the use of emotional cruelty, purposefully manipulating others through the use of fear, and a preoccupation with violence.

Theodore Millon claimed there were four subtypes of sadism, which he termed enforcing sadism, explosive sadism, spineless sadism, and tyrannical sadism.

SubtypeDescriptionPersonality Traits
Spineless SadismIncluding avoidant featuresInsecure, bogus, and cowardly; venomous dominance and cruelty is counterphobic; weakness counteracted by group support; public swaggering; selects powerless scapegoats.
Tyrannical SadismIncluding negativistic featuresRelishes menacing and brutalising others, forcing them to cower and submit; verbally cutting and scathing, accusatory and destructive; intentionally surly, abusive, inhumane, unmerciful.
Enforcing SadismIncluding compulsive featuresHostility sublimated in the “public interest,” cops, “bossy” supervisors, deans, judges; possesses the “right” to be pitiless, merciless, coarse, and barbarous; task is to control and punish, to search out rule breakers.
Explosive SadismIncluding borderline featuresUnpredictably precipitous outbursts and fury; uncontrollable rage and fearsome attacks; feelings of humiliation are pent-up and discharged; subsequently contrite.

Comorbidity with other Personality Disorders

Sadistic personality disorder has been found to occur frequently in unison with other personality disorders. Studies have also found that sadistic personality disorder is the personality disorder with the highest level of comorbidity to other types of psychopathological disorders. In contrast, sadism has also been found in patients who do not display any or other forms of psychopathic disorders. One personality disorder that is often found to occur alongside sadistic personality disorder is conduct disorder, not an adult disorder but one of childhood and adolescence. Studies have found other types of illnesses, such as alcoholism, to have a high rate of comorbidity with sadistic personality disorder.

Researchers have had some level of difficulty distinguishing sadistic personality disorder from other forms of personality disorders due to its high level of comorbidity with other disorders.

Removal from the DSM

Numerous theorists and clinicians introduced sadistic personality disorder to the DSM in 1987 and it was placed in the DSM-III-R as a way to facilitate further systematic clinical study and research. It was proposed to be included because of adults who possessed sadistic personality traits but were not being labelled, even though their victims were being labelled with a self-defeating personality disorder. Theorists like Theodore Millon wanted to generate further study on SPD, and so proposed it to the DSM-IV Personality Disorder Work Group, who rejected it. Millon writes that “Physically abusive, sadistic personalities are most often male, and it was felt that any such diagnosis might have the paradoxical effect of legally excusing cruel behavior.”

Sub-Clinical Sadism in Personality Psychology

There is renewed interest in studying sadism as a personality trait. Sadism joins with subclinical psychopathy, narcissism, and Machiavellianism to form the so-called “dark tetrad” of personality.

What is Neuroticism?

Introduction

In the study of psychology, neuroticism has been considered a fundamental personality trait.

For example, in the Big Five approach to personality trait theory, individuals with high scores for neuroticism are more likely than average to be moody and to experience such feelings as anxiety, worry, fear, anger, frustration, envy, jealousy, guilt, depressed mood, and loneliness. Such people are thought to respond worse to stressors and are more likely to interpret ordinary situations, such as minor frustrations, as appearing hopelessly difficult. They are described as often being self-conscious and shy, and tending to have trouble controlling urges and delaying gratification.

People with high scores on the neuroticism index are thought to be at risk of developing common mental disorders (mood disorders, anxiety disorders, and substance use disorders have been studied), and the sorts of symptoms traditionally referred to as “neuroses”.

Refer to Neurosis and Neurotic Personality Questionnaire KON-2006.

Definition

Neuroticism is a trait in many models within personality theory, but there is significant disagreement on its definition. It is sometimes defined as a tendency for quick arousal when stimulated and slow relaxation from arousal, especially with regard to negative emotional arousal. Another definition focuses on emotional instability and negativity or maladjustment, in contrast to emotional stability and positivity, or good adjustment. It has also been defined in terms of lack of self-control, poor ability to manage psychological stress, and a tendency to complain.

Various personality tests produce numerical scores, and these scores are mapped onto the concept of “neuroticism” in various ways, which has created some confusion in the scientific literature, especially with regard to sub-traits or “facets”.

Individuals who score low in neuroticism tend to be more emotionally stable and less reactive to stress. They tend to be calm, even-tempered, and less likely to feel tense or rattled. Although they are low in negative emotion, they are not necessarily high in positive emotion. Being high in scores of positive emotion is generally an element of the independent trait of extraversion. Neurotic extraverts, for example, would experience high levels of both positive and negative emotional states, a kind of “emotional roller coaster”.

Measurement

Like other personality traits, neuroticism is typically viewed as a continuous dimension rather than a discrete state.

The extent of neuroticism is generally assessed using self-report measures, although peer-reports and third-party observation can also be used. Self-report measures are either lexical or based on statements. Deciding which measure of either type to use in research is determined by an assessment of psychometric properties and the time and space constraints of the study being undertaken.

Lexical measures use individual adjectives that reflect neurotic traits, such as anxiety, envy, jealousy, and moodiness, and are very space and time efficient for research purposes. Lewis Goldberg (1992) developed a 20-word measure as part of his 100-word Big Five markers. Saucier (1994) developed a briefer 8-word measure as part of his 40-word mini-markers. Thompson (2008) systematically revised these measures to develop the International English Mini-Markers which has superior validity and reliability in populations both within and outside North America. Internal consistency reliability of the International English Mini-Markers for the Neuroticism (emotional stability) measure for native English-speakers is reported as 0.84, and that for non-native English-speakers is 0.77.

Statement measures tend to comprise more words, and hence consume more research instrument space, than lexical measures. Respondents are asked the extent to which they, for example, “Remain calm under pressure”, or “Have frequent mood swings”. While some statement-based measures of neuroticism have similarly acceptable psychometric properties in North American populations to lexical measures, their generally emic development makes them less suited to use in other populations. For instance, statements in colloquial North American English like “Seldom feel blue” and “Am often down in the dumps” are sometimes hard for non-native English-speakers to understand.

Neuroticism has also been studied from the perspective of Gray’s biopsychological theory of personality, using a scale that measures personality along two dimensions: the behavioural inhibition system (BIS) and the behavioural activation system (BAS). The BIS is thought to be related to sensitivity to punishment as well as avoidance motivation, while the BAS is thought to be related to sensitivity to reward as well as approach motivation. Neuroticism has been found to be positively correlated with the BIS scale, and negatively correlated with the BAS scale.

Neuroticism has been included as one of the four dimensions that comprise core self-evaluations, one’s fundamental appraisal of oneself, along with locus of control, self-efficacy, and self-esteem. The concept of core self-evaluations was first examined by Judge, Locke, and Durham (1997), and since then evidence has been found to suggest these have the ability to predict several work outcomes, specifically, job satisfaction and job performance.

There is a risk of selection bias in surveys of neuroticism; a 2012 review of N-scores said that “many studies used samples drawn from privileged and educated populations”.

Neuroticism is highly correlated with the startle reflex in response to fearful conditions and inversely correlated with it in response to disgusting or repulsive stimuli. This suggests that Neuroticism may increase vigilance where evasive action is possible but promote emotional blunting when escape is not an option. A measure of the startle reflex can be used to predict the trait neuroticism with good accuracy; a fact that is thought by some to underlie the neurological basis of the trait. The startle reflex is a reflex in response to a loud noise that one typically has no control over, though anticipation can reduce the effect. The strength of the reflex as well as the time until the reflex ceases can be used to predict neuroticism.

Mental Disorder Correlations

Questions used in many neuroticism scales overlap with instruments used to assess mental disorders like anxiety disorders (especially social anxiety disorder) and mood disorders (especially major depressive disorder), which can sometimes confound efforts to interpret N scores and makes it difficult to determine whether each of neuroticism and the overlapping mental disorders might cause the other, or if both might stem from other cause. Correlations can be identified.

A 2013 meta-analysis found that a wide range of clinical mental disorders are associated with elevated levels of neuroticism compared to levels in the general population. It found that high neuroticism is predictive for the development of anxiety disorders, major depressive disorder, psychosis, and schizophrenia, and is predictive but less so for substance use and non-specific mental distress. These associations are smaller after adjustment for elevated baseline symptoms of the mental illnesses and psychiatric history.

Neuroticism has also been found to be associated with older age. In 2007, Mroczek & Spiro found that among older men, upward trends in neuroticism over life as well as increased neuroticism overall both contributed to higher mortality rates.

Mood Disorders

Disorders associated with elevated neuroticism include mood disorders, such as depression and bipolar disorder, anxiety disorders, eating disorders, schizophrenia and schizoaffective disorder, dissociative identity disorder, and hypochondriasis. Mood disorders tend to have a much larger association with neuroticism than most other disorders. The five big studies have described children and adolescents with high neuroticism as “anxious, vulnerable, tense, easily frightened, ‘falling apart’ under stress, guilt-prone, moody, low in frustration tolerance, and insecure in relationships with others,” which includes both traits concerning the prevalence of negative emotions as well as the response to these negative emotions. Neuroticism in adults similarly was found to be associated with the frequency of self-reported problems.

These associations can vary with culture: for example, Adams found that among upper-middle-class American teenaged girls, neuroticism was associated with eating disorders and self-harm, but among Ghanaian teenaged girls, higher neuroticism was associated with magical thinking and extreme fear of enemies.

Personality Disorders

A 2004 meta-analysis attempted to analyse personality disorders in light of the five-factor personality theory and failed to find meaningful discriminations; it did find that elevated neuroticism is correlated with many personality disorders.

Theories of Causation

Mental-Noise Hypothesis

Studies have found that the mean reaction times will not differ between individuals high in neuroticism and those low in neuroticism, but that, with individuals high in neuroticism, there is considerably more trial-to-trial variability in performance reflected in reaction time standard deviations. In other words, on some trials neurotic individuals are faster than average, and on others they are slower than average. It has been suggested that this variability reflects noise in the individual’s information processing systems or instability of basic cognitive operations (such as regulation processes), and further that this noise originates from two sources: mental preoccupations and reactivity processes.

Flehmig et al. (2007) studied mental noise in terms of everyday behaviours using the Cognitive Failures Questionnaire, which is a self-report measure of the frequency of slips and lapses of attention. A “slip” is an error by commission, and a “lapse” is an error by omission. This scale was correlated with two well-known measures of neuroticism, the BIS/BAS scale and the Eysenck Personality Questionnaire. Results indicated that the CFQ-UA (Cognitive Failures Questionnaire- Unintended Activation) subscale was most strongly correlated with neuroticism (r = .40) and explained the most variance (16%) compared to overall CFQ scores, which only explained 7%. The authors interpret these findings as suggesting that mental noise is “highly specific in nature” as it is related most strongly to attention slips triggered endogenously by associative memory. In other words, this may suggest that mental noise is mostly task-irrelevant cognitions such as worries and preoccupations.

Evolutionary Psychology

The theory of evolution may also explain differences in personality. For example, one of the evolutionary approaches to depression focuses on neuroticism and finds that heightened reactivity to negative outcomes may have had a survival benefit, and that furthermore a positive relationship has been found between neuroticism level and success in university with the precondition that the negative effects of neuroticism are also successfully coped with. Likewise, a heightened reactivity to positive events may have had reproductive advantages, selecting for heightened reactivity generally. Nettle contends that evolution selected for higher levels of neuroticism until the negative effects of neuroticism outweighed its benefits, resulting in selection for a certain optimal level of neuroticism. This type of selection will result in a normal distribution of neuroticism, so the extremities of the distribution will be individuals with excessive neuroticism or too low neuroticism for what is optimal, and the ones with excessive neuroticism would therefore be more vulnerable to the negative effects of depression, and Nettle gives this as the explanation for the existence of depression rather than hypothesizing, as others have, that depression itself has any evolutionary benefit.

Some research has found that neuroticism, in modern societies, is positively correlated with reproductive success in females but not in males. A possible explanation may be that neuroticism in females comes at the expense of formal education (which is correlated with lower fertility) and correlates with unplanned and adolescent pregnancies.

Terror Management Theory

According to terror management theory (TMT) neuroticism is primarily caused by insufficient anxiety buffers against unconscious death anxiety. These buffers consist of:

  • Cultural worldviews that impart life with a sense of enduring meaning, such as social continuity beyond one’s death, future legacy and afterlife beliefs, and
  • A sense of personal value, or the self-esteem in the cultural worldview context, an enduring sense of meaning.

While TMT agrees with standard evolutionary psychology accounts that the roots of neuroticism in Homo sapiens or its ancestors are likely in adaptive sensitivities to negative outcomes, it posits that once Homo sapiens achieved a higher level of self-awareness, neuroticism increased enormously, becoming largely a spandrel, a non-adaptive by-product of our adaptive intelligence, which resulted in a crippling awareness of death that threatened to undermine other adaptive functions. This overblown anxiety thus needed to be buffered via intelligently creative, but largely fictitious and arbitrary notions of cultural meaning and personal value. Since highly religious or supernatural conceptions of the world provide “cosmic” personal significance and literal immortality, they are deemed to offer the most efficient buffers against death anxiety and neuroticism. Thus, historically, the shift to more materialistic and secular cultures – starting in the Neolithic, and culminating in the industrial revolution, is deemed to have increased neuroticism.

Genetic and Environmental Factors

A 2013 review found that “Neuroticism is the product of the interplay between genetic and environmental influences. Heritability estimates typically range from 40% to 60%.” The effect size of these genetic differences remain largely the same throughout development, but the hunt for any specific genes that control neuroticism levels has “turned out to be difficult and hardly successful so far.” On the other hand, with regards to environmental influences, adversities during development such as “emotional neglect and sexual abuse” were found to be positively associated with neuroticism. However, “sustained change in neuroticism and mental health are rather rare or have only small effects.”

In the July 1951 article: “The Inheritance of Neuroticism” by Hans J. Eysenck and Donald Prell it was reported that some 80 per cent of individual differences in neuroticism are due to heredity and only 20 percent are due to environment….the factor of neuroticism is not a statistical artifact, but constitutes a biological unit which is inherited as a whole….neurotic predisposition is to a large extent hereditarily determined.

In children and adolescents, psychologists speak of temperamental negative affectivity that, during adolescence, develops into the neuroticism personality domain. Mean neuroticism levels change throughout the lifespan as a function of personality maturation and social roles, but also the expression of new genes. Neuroticism in particular was found to decrease as a result of maturity by decreasing through age 40 and then levelling off. Generally speaking, the influence of environments on neuroticism increases over the lifespan, although people probably select and evoke experiences based on their neuroticism levels.

The emergent field of “imaging genetics,” which investigates the role of genetic variation in the structure and function of the brain, has studied certain genes suggested to be related to neuroticism, and the one studied so far concerning this topic has been the serotonin transporter-linked promoter region gene known as 5-HTTLPR, which is transcribed into a serotonin transporter that removes serotonin. It has been found that compared to the long (l) variant of 5-HTTLPR, the short (s) variant has reduced promoter activity, and the first study on this subject has shown that the presence of the s-variant 5-HTTLPR has been found to result in higher amygdala activity from seeing angry or fearful faces while doing a non-emotional task, with further studies confirming that the s-variant 5-HTTLPR result greater amygdala activity in response to negative stimuli, but there have also been null findings. A meta-analysis of 14 studies has shown that this gene has a moderate effect size and accounts for 10% of the phenotypic difference. However, the relationship between brain activity and genetics may not be completely straightforward due to other factors, with suggestions made that cognitive control and stress may moderate the effect of the gene. There are two models that have been proposed to explain the type of association between the 5-HTTLPR gene and amygdala activity: the “phasic activation” model proposes that the gene controls amygdala activity levels in response to stress, whereas the “tonic activation” model, on the other hand, proposes that the gene controls baseline amygdala activity. Another gene that has been suggested for further study to be related to neuroticism is the catechol-O-methyltransferase (COMT) gene.

The anxiety and maladaptive stress responses that are aspects of neuroticism have been the subject of intensive study. Dysregulation of hypothalamic-pituitary-adrenal axis and glucocorticoid system, and influence of different versions of the serotonin transporter and 5-HT1A receptor genes may influence the development of neuroticism in combination with environmental effects like the quality of upbringing.

Neuroimaging studies with fMRI have had mixed results, with some finding that increased activity in the amygdala and anterior cingulate cortex, brain regions associated with arousal, is correlated with high neuroticism scores, as is activation of the associations have also been found with the medial prefrontal cortex, insular cortex, and hippocampus, while other studies have found no correlations. Further studies have been conducted trying to tighten experimental design by using genetics to add additional differentiation among participants, as well as twin study models.

A related trait, behavioural inhibition, or “inhibition to the unfamiliar,” has received attention as the trait concerning withdrawal or fear from unfamiliar situations, which is generally measured through observation of child behaviour in response to, for example, encountering unfamiliar individuals. This trait in particular has been hypothesized to be related to amygdala function, but the evidence so far has been mixed.

Age, Gender, and Geographic Patterns

A 2013 review found that groups associated with higher levels of neuroticism are young adults who are at high risk for mood disorders. Research in large samples has shown that levels of neuroticism are higher in women than men. Neuroticism is found to decrease slightly with age. The same study noted that no functional MRI studies have yet been performed to investigate these differences, calling for more research. A 2010 review found personality differences between genders to be between “small and moderate,” the largest of those differences being in the traits of agreeableness and neuroticism. Many personality traits were found to have had larger personality differences between men and women in developed countries compared to less developed countries, and differences in three traits – extraversion, neuroticism, and people-versus-thing orientation – showed differences that remained consistent across different levels of economic development, which is also consistent with the “possible influence of biologic factors.” Three cross-cultural studies have revealed higher levels of female neuroticism across almost all nations.

Geographically, a 2016 review said that in the US, neuroticism is highest in the mid-Atlantic states and southwards and declines westward, while openness to experience is highest in ethnically diverse regions of the mid-Atlantic, New England, the West Coast, and cities. Likewise, in the UK neuroticism is lowest in urban areas. Generally, geographical studies find correlations between low neuroticism and entrepreneurship and economic vitality and correlations between high neuroticism and poor health outcomes. The review found that the causal relationship between regional cultural and economic conditions and psychological health is unclear.

What is Sensory Processing Sensitivity?

Introduction

Sensory processing sensitivity (SPS) is a temperamental or personality trait involving “an increased sensitivity of the central nervous system and a deeper cognitive processing of physical, social and emotional stimuli”.

The trait is characterised by “a tendency to ‘pause to check’ in novel situations, greater sensitivity to subtle stimuli, and the engagement of deeper cognitive processing strategies for employing coping actions, all of which is driven by heightened emotional reactivity, both positive and negative”.

A human with a particularly high measure of SPS is considered to have “hypersensitivity”, or be a highly sensitive person (HSP). The terms SPS and HSP were coined in the mid-1990s by psychologists Elaine Aron and her husband Arthur Aron, who developed the Highly Sensitive Person Scale (HSPS) questionnaire by which SPS is measured. Other researchers have applied various other terms to denote this responsiveness to stimuli that is seen in humans and other species.

According to the Arons and colleagues, people with high SPS make up about 15-20% of the population. Although some researchers consistently related high SPS to negative outcomes, other researchers have associated it with increased responsiveness to both positive and negative influences. Aron and colleagues state that the high-SPS personality trait is not a disorder.

Origin and Development of the Terms

Elaine Aron’s book The Highly Sensitive Person was published in 1996. In 1997 Elaine and Arthur Aron formally identified sensory processing sensitivity (SPS) as the defining trait of highly sensitive persons (HSPs). The popular terms hypersensitivity (not to be confused with the medical term hypersensitivity) or highly sensitive are popular synonyms for the scientific concept of SPS. By way of definition, Aron and Aron (1997) wrote that sensory processing here refers not to the sense organs themselves, but to what occurs as sensory information is transmitted to or processed in the brain. They assert that the trait is not a disorder but an innate survival strategy that has both advantages and disadvantages.

Elaine Aron’s academic journal articles as well as self-help publications for the lay reader have focused on distinguishing high SPS from socially reticent behaviour and disorders with which high SPS can be confused; overcoming the social unacceptability that can cause low self-esteem; and emphasizing the advantages of high SPS to balance the disadvantages emphasized by others.

In 2015, sociologist Elizabeth Bernstein wrote in The Wall Street Journal that HSPs were “having a moment,” noting that several hundred research studies had been conducted on topics related to HSPs’ high sensitivity. The First International Scientific Conference on High Sensitivity or Sensory Processing Sensitivity was held at the Vrije Universiteit Brussel. By 2015, more than a million copies of The Highly Sensitive Person had been sold.

Earlier Research

Research pre-dating the Arons’ coining of the term “high sensitivity” includes that of German medicine professor Wolfgang Klages, who argued in the 1970s that the phenomenon of sensitive and highly sensitive humans is “biologically anchored” and that the “stimulus threshold of the thalamus” is much lower in these persons. As a result, said Klages, there is a higher permeability for incoming signals from afferent nerve fibres so that they pass “unfiltered” to the cerebral cortex.

The Arons (1997) recognised psychologist Albert Mehrabian’s (1976, 1980, 1991) concept of filtering the “irrelevant”, but wrote that the concept implied that the inability of HSPs’ (Mehrabian’s “low screeners”) to filter out what is irrelevant would imply that what is relevant is determined from the perspective of non-HSPs (“high screeners”).

Attributes, Characteristics and Prevalence

Boterberg et al. (2016) describe high SPS as a “temperamental or personality trait which is present in some individuals and reflects an increased sensitivity of the central nervous system and a deeper cognitive processing of physical, social and emotional stimuli”.

People with high SPS report having a heightened response to stimuli such as pain, caffeine, hunger, and loud noises. According to Boterberg et al., these individuals are “believed to be easily overstimulated by external stimuli because they have a lower perceptual threshold and process stimuli cognitively deeper than most other people.” This deeper processing may result in increased reaction time as more time is spent responding to cues in the environment, and might also contribute to cautious behaviour and low risk-taking.

The HSP Scale, initially (1997) a questionnaire designed to measure SPS on a unidimensional scale, was subsequently decomposed into two, three, or four factors or sub-scales. Most components have been associated with traditionally accepted negative psychological outcomes including high stress levels, being easily overwhelmed, increased rates of depression, anxiety, and sleep problems, as well as symptoms of autism; the diathesis-stress model focused on increased vulnerability to negative influences. However, the differential susceptibility theory (DST) and biological sensitivity to context theory (BSCT) and sensory processing sensitivity (SPS) suggest increased plasticity in terms of responsiveness to both positive and negative influences; and the vantage sensitivity (VS) concept emphasizes increased responsiveness to positive experiences. Researchers such as Smolewska et al. (2006) said positive outcomes were more common in individuals with high aesthetic sensitivity, who tend to experience heightened positive emotions in response to rewarding stimuli and more likely to score high on “openness” on the Big Five factors model.

Research in evolutionary biology provides evidence that the trait of SPS can be observed, under various terms, in over 100 nonhuman species, Aron writing that the SPS trait is meant to encompass what personality psychologists have described under various other names. Conversely, Aron has distinguished SPS from what she considers it is not, explicitly distinguishing high SPS from possibly similar-appearing traits or disorders (such as shyness, sensation-seeking, sensory processing disorder, and autism), and further, that SPS may be a basic variable that may underlie multiple other trait differences (such as introversion versus extraversion). Contrary to common misconception, according to Aron HSPs include both introverts and extroverts, and may be simultaneously high-sensation seeking and cautious.

In humans and other species, responsive and unresponsive individuals coexist and consistently display different levels of responsiveness to environmental stimuli, the different levels of responsiveness having corresponding evolutionary costs and benefits. This observation parallels Aron’s assertion that high SPS is not a disorder, but rather a personality trait with attendant advantages and disadvantages. Accordingly, Aron cautions medical professionals against prescribing psychoactive medications to “cure” the trait, which may or may not coexist with an actual disorder.

By 2015 the trait had been documented at various levels of study, including temperament and behaviour psychology, brain function and neuronal sensitization, and genetics. For example, genetic studies provide evidence that higher levels of SPS are linked to the serotonin transporter 5-HTTLPR short/short genotype, polymorphisms in dopamine neurotransmitter genes,[37] and the ADRA2b norepinephrine-related gene variant.

HSP Scale score patterns in adults were thought to be distributed as a dichotomous categorical variable with a break point between 10% and 35%, with Aron choosing a cut-off of the highest-scoring 20% of individuals to define the HSP category. A 2019 review article stated that findings suggest people fall into three sensitivity groups along a normal distribution sensitivity continuum.

What is Avoidant Personality Disorder?

Introduction

Avoidant personality disorder (AvPD) is a Cluster C personality disorder in which the main coping mechanism of those affected is avoidance of feared stimuli.

Those affected display a pattern of severe social anxiety, social inhibition, feelings of inadequacy and inferiority, extreme sensitivity to negative evaluation and rejection, and avoidance of social interaction despite a strong desire for intimacy.

People with AvPD often consider themselves to be socially inept or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked. They often avoid becoming involved with others unless they are certain they will be liked.

Childhood emotional neglect (in particular, the rejection of a child by one or both parents) and peer group rejection are associated with an increased risk for its development; however, it is possible for AvPD to occur without any notable history of abuse or neglect.

Brief History

The avoidant personality has been described in several sources as far back as the early 1900s, although it was not so named for some time. Swiss psychiatrist Eugen Bleuler described patients who exhibited signs of avoidant personality disorder in his 1911 work Dementia Praecox: Or the Group of Schizophrenias. Avoidant and schizoid patterns were frequently confused or referred to synonymously until Kretschmer (1921), in providing the first relatively complete description, developed a distinction.

Signs and Symptoms

Avoidant individuals are preoccupied with their own shortcomings and form relationships with others only if they believe they will not be rejected. They often view themselves with contempt, while showing a decreased ability to identify traits within themselves that are generally considered as positive within their societies. Loss and social rejection are so painful that these individuals will choose to be alone rather than risk trying to connect with others.

Some with this disorder fantasize about idealized, accepting and affectionate relationships because of their desire to belong. They often feel themselves unworthy of the relationships they desire, and shame themselves from ever attempting to begin them. If they do manage to form relationships, it is also common for them to pre-emptively abandon them out of fear of the relationship failing.

Individuals with the disorder tend to describe themselves as uneasy, anxious, lonely, unwanted and isolated from others. They often choose jobs of isolation in which they do not have to interact with others regularly. Avoidant individuals also avoid performing activities in public spaces for fear of embarrassing themselves in front of others.

Symptoms include:

  • Extreme shyness or anxiety in social situations, though the person feels a strong desire for close relationships;
  • Heightened attachment-related anxiety, which may include a fear of abandonment; and
  • Substance abuse and/or dependence.

Comorbidity

AvPD is reported to be especially prevalent in people with anxiety disorders, although estimates of comorbidity vary widely due to differences in (among others) diagnostic instruments. Research suggests that approximately 10-50% of people who have panic disorder with agoraphobia have avoidant personality disorder, as well as about 20-40% of people who have social anxiety disorder. In addition to this, AvPD is more prevalent in people who have comorbid social anxiety disorder and generalised anxiety disorder (GAD) than in those who have only one of the aforementioned conditions.

Some studies report prevalence rates of up to 45% among people with GAD and up to 56% of those with obsessive-compulsive disorder. Posttraumatic stress disorder is also commonly comorbid with AvPD.

Avoidants are prone to self-loathing and, in certain cases, self-harm. In particular, avoidants who have comorbid PTSD have the highest rates of engagement in self-harming behaviour, outweighing even those with borderline personality disorder (with or without PTSD). Substance use disorders are also common in individuals with AvPD – particularly in regard to alcohol, benzodiazepines and heroin – and may significantly affect a patient’s prognosis.

Earlier theorists proposed a personality disorder with a combination of features from borderline personality disorder and avoidant personality disorder, called “avoidant-borderline mixed personality” (AvPD/BPD).

Causes

Causes of AvPD are not clearly defined, but appear to be influenced by a combination of social, genetic and psychological factors. The disorder may be related to temperamental factors that are inherited.

Specifically, various anxiety disorders in childhood and adolescence have been associated with a temperament characterised by behavioural inhibition, including features of being shy, fearful and withdrawn in new situations. These inherited characteristics may give an individual a genetic predisposition towards AvPD.

Childhood emotional neglect and peer group rejection are both associated with an increased risk for the development of AvPD. Some researchers believe a combination of high-sensory-processing sensitivity coupled with adverse childhood experiences may heighten the risk of an individual developing AvPD.

Subtypes

Millon

Psychologist Theodore Millon notes that because most patients present a mixed picture of symptoms, their personality disorder tends to be a blend of a major personality disorder type with one or

more secondary personality disorder types. He identified four adult subtypes of AvPD as outlined below.

SubtypePersonality Traits/Features
Phobic Avoidant (including dependent features)General apprehensiveness displaced with avoidable tangible precipitant; qualms and disquietude symbolised by a repugnant and specific dreadful object or circumstances.
Conflicted Avoidant (including negativistic features)Internal discord and dissension; fears dependence; unsettled; unreconciled within self; hesitating, confused, tormented, paroxysmic, embittered; and unresolvable angst.
Hypersensitive Avoidant (including paranoid features)Intensely wary and suspicious; alternatively panicky, terrified, edgy, and timorous, then thin-skinned, high-strung, petulant, and prickly.
Self-Deserting Avoidant (including depressive features)Blocks or fragments self-awareness; discards painful images and memories; casts away untenable thoughts and impulses; ultimately jettisons self (suicidal).

Others

In 1993, Lynn E. Alden and Martha J. Capreol proposed two other subtypes of avoidant personality disorder, as outlined below.

SubtypePersonality Traits/Features
Cold-AvoidantCharacterised by an inability to experience and express positive emotion towards others.
Exploitable-AvoidantCharacterised by an inability to express anger towards others or to resist coercion from others. May be at risk for abuse by others.

Diagnosis

ICD

The World Health Organisation’s ICD-10 lists avoidant personality disorder as anxious (avoidant) personality disorder (F60.6).

It is characterised by the presence of at least four of the following:

  1. Persistent and pervasive feelings of tension and apprehension.
  2. Belief that one is socially inept, personally unappealing, or inferior to others.
  3. Excessive preoccupation with being criticised or rejected in social situations.
  4. Unwillingness to become involved with people unless certain of being liked.
  5. Restrictions in lifestyle because of need to have physical security.
  6. Avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection.

Associated features may include hypersensitivity to rejection and criticism.

It is a requirement of ICD-10 that all personality disorder diagnoses also satisfy a set of general personality disorder criteria.

DSM

The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the APA also has an avoidant personality disorder diagnosis (301.82). It refers to a widespread pattern of inhibition around people, feeling inadequate and being very sensitive to negative evaluation. Symptoms begin by early adulthood and occur in a range of situations.

Four of the following seven specific symptoms should be present:

  1. Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection.
  2. Is unwilling to get involved with people unless certain of being liked.
  3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
  4. Is preoccupied with being criticised or rejected in social situations.
  5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
  6. Views self as socially inept, personally unappealing, or inferior to others.
  7. Is unusually reluctant to take personal risk or to engage in any new activities because they may prove embarrassing.

Differential Diagnosis

In contrast to social anxiety disorder, a diagnosis of AvPD also requires that the general criteria for a personality disorder are met.

According to the DSM-5, avoidant personality disorder must be differentiated from similar personality disorders such as dependent, paranoid, schizoid, and schizotypal. But these can also occur together; this is particularly likely for AvPD and dependent personality disorder. Thus, if criteria for more than one personality disorder are met, all can be diagnosed.

There is also an overlap between avoidant and schizoid personality traits and AvPD may have a relationship to the schizophrenia spectrum.

Epidemiology

Data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions indicates a prevalence of 2.36% in the US general population. It appears to occur with equal frequency in males and females. In one study, it was seen in 14.7% of psychiatric outpatients.

Criticism

There is controversy as to whether avoidant personality disorder (AvPD) is distinct from generalised social anxiety disorder. Both have similar diagnostic criteria and may share a similar causation, subjective experience, course, treatment and identical underlying personality features, such as shyness.

It is contended by some that they are merely different conceptualisations of the same disorder, where avoidant personality disorder may represent the more severe form. In particular, those with AvPD experience not only more severe social phobia symptoms, but are also more depressed and more functionally impaired than patients with generalised social phobia alone. But they show no differences in social skills or performance on an impromptu speech. Another difference is that social phobia is the fear of social circumstances whereas AvPD is better described as an aversion to intimacy in relationships.

Treatment

Treatment of avoidant personality disorder can employ various techniques, such as social skills training, psychotherapy, cognitive therapy, and exposure treatment to gradually increase social contacts, group therapy for practicing social skills, and sometimes drug therapy.

A key issue in treatment is gaining and keeping the patient’s trust since people with an avoidant personality disorder will often start to avoid treatment sessions if they distrust the therapist or fear rejection. The primary purpose of both individual therapy and social skills group training is for individuals with an avoidant personality disorder to begin challenging their exaggerated negative beliefs about themselves.

Significant improvement in the symptoms of personality disorders is possible, with the help of treatment and individual effort.

Prognosis

Being a personality disorder, which is usually chronic and has long-lasting mental conditions, an avoidant personality disorder is not expected to improve with time without treatment. Given that it is a poorly studied personality disorder and in light of prevalence rates, societal costs, and the current state of research, AvPD qualifies as a neglected disorder.

Can We Link Personality Pathology with Smoking & Traits?

Research Paper Title

Predicting smoking and nicotine dependence from the DSM-5 alternative model for personality pathology.

Background

Individuals with personality disorders (PDs) have higher morbidity and mortality than the general population, which may be due to maladaptive health behaviours such as smoking.

Previous studies have examined the links between categorical PD diagnoses/personality traits and smoking/nicotine dependence, but little is known about how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders relates to smoking and nicotine dependence.

Methods

The current study examined this question in a sample of 500 participants using the Levels of Personality Functioning Scale to assess general personality pathology, the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to measure specific traits, the Fagerström test for Nicotine Dependence to assess nicotine dependence, and questions about current and past smoking to assess smoking status (i.e. current, former, never).

Results

Multinomial logistic regression results demonstrated that general personality pathology (Criterion A) was not related to smoking status, and there were no reliable associations between traits (Criterion B) and smoking status. However, correlations showed that higher negative affectivity and disinhibition were related to higher levels of nicotine dependence within smokers.

Conclusions

Findings are discussed in regard to previous findings linking personality pathology to smoking/nicotine dependence as well as the general validity of this new personality disorder diagnostic system.

Reference

Halberstadt, A.L., Skrzynski, C.J., Wright, A.G.C. & Creswell, K.G. (2021) Predicting smoking and nicotine dependence from the DSM-5 alternative model for personality pathology. Personality Disorders. doi: 10.1037/per0000487. Online ahead of print.