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Personality & Relapse

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Posted On: April 13, 2002          Updated On: April 18, 2002
© Terence T. Gorski, 2001

Personality & Relapse
By Terence T. Gorski
April 13, 2002

  <Books On Personality & Relapse>

In describing the role of personality styles in relapse I relied on a variety of different sources.  This article is intended to briefly discuss the major works that have shaped my thinking in this area.  

DSM Personality Disorders

First, I reviewed the section of the DSM personality disorders.  When I started my study I used DSM-III which was then revised as DSM-IV.  DSM-IV gives the following definition of personality disorder:  "A personality disorder is defined as " an enduring pattern of inner experience  and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment."   

The DSM-IV describes ten specific personality disorders.  These ten personality styles are then divided into three clusters - Cluster A, Cluster B, and Cluster C.   

Cluster A:  Paranoid, Schizoid, and schizotypal.  I call these these the dysfunctional personality styles because they are generally accompanied by other Axis I mental disorders.  

Cluster B:  Antisocial, Borderline, Histrionic, Narcissistic.

Cluster C:  Avoidant, Dependent, Obsessive Compulsive, and Passive Aggressive.  The Passive Aggressive Personality Disorder was removed in DSM-IV to a "further study" section with a secondary name of "Negativistic Personality Disorder".  I still list it because i find it so helpful in working with addicted people who are passive resistant in their form of denial.  

I always found the DSM Personality Disorders difficult to use in actual counseling with clients.  I had trouble understanding how the personality styles related to each other and to addiction.  Most of my clients found it impossible.  Each personality disorder has a complicated name that is properly described as psychological jargon or psychobabble.  The DSM also fails to give health variations of the personality disorders, so its easy to find what is wrong about a recovering person's personality but makes it difficult to assess strengths or to set concrete and specific goals for personal change.

The book DSM-IV Made Simple by James Morrison helped me to make clear distinctions between the Axis II personality disorders, the Axis I Mental Disorders, and the Axis I Substance-related Disorders.  

I still found the descriptions of the DSM IV Personality Disorders difficult to understand and distinguish from one another.  It seemed to me that the list of symptoms were poorly related to each other and that there must be some underlying core dynamics that could help me to understand the relationship among the personality disorders more clearly.  

The Shostrom Personality Styles

I remembered an old book, Man The Manipulator by Everett L. Shostrom, that I had used in my early days of doing addiction counseling. (This book is currently out of print but you can search for a used copy <Click Here>).   This book built a personality style system that differentiate two general personality types - the top dog, who must be better than and can never be equal to or less than others, and the underdog, who must appear to be less than others and believing they can never appear to be equal to or better than others).  

These two personality types are further broken down in eight different personality styles, each containing a healthy or self-actualizing style and a self-defeating or manipulative style: 

The first four personality styles are linked to the Top Dog Personality Type.  These are:  (1) Expresser - Judge;  (2)  Asserter - Bully; (3) Respecter - Calculator;  (4) Leader - Dictator;  

The second four personality styles are linked to the Under Dog Personality Type.  These are:  (5) Guide - Protector;  (6) Carer - Nice Guy;  (7) Appreciator - Clinging Vine; and (8) Empathizer - Weakling.

The recovering people that i worked with found it easier to relate to these eight personality styles than to the DSM personality diagnostic categories.  I think this was because the names of the Shostrom personality styles were expressed in plain and common sense language instead of the complex psychological jargon (psychobabble) used by the DSM.   I was not able, however, to make a direct connection between the Shostrom Personality Styles and the DSM Personality Disorders.  So I kept looking.  

The Millon Personality System

What I then found was the work of Theodore Millon.  First I read the book Disorders of PersonalityI read an early version based on the DSM III.  The new version is based on the DSM-IV <Review the DSM-IV Version>.  I struggled through this book.  It was a difficult read but I felt the pieces beginning to come together in my mind.  Then I discovered a clear and simple explanation of Millon's system that helped the conceptual pieces to fall into place in my mind.  That book was  Personality and Its Disorders by Millon and Everly.  Here's a summary of Millon's Personality System.

Millon calls his theory a Biosocial Learning Model of Personality Development.  In essence, this approach supports the Biopsychosocial which is one of the core theoretical models that supports the CENAPS Model.  Millon, however, describes the components of the biopsychosocial model using slightly different categories than the CENAPS model.  

Millon's Definition of Personality:  Millon defines personality  as "a pattern of deeply embedded and broadly exhibited cognitive, affective, and overt behavioral traits that persist over a significant period of time.  These traits emerge from a complicated matrix of biological predispositions and experiential learning that occurs in a social context.  Lying at the core of personality are two processes:  (1) how the person interacts with the demand of the environment, and (2) how the individual relates to self.   

Millon's Biopsychosocial Continuum:  Millon describes the biopsychosocial continuum using five distinct levels or dimensions:

1.    Behavioral Appearance:  This dimension describes what a person does and how they behave in ways that can be observed by other people.

2.    Interpersonal Conduct:   This dimension describes how a person typically related to other people.  

3.    Cognitive Style:  This dimension describes how a person organizes their thinking and decision making rules that guide the conduct of the day-to-day living.  

4.    Affective Expression:  This dimension describes how a person organizes themselves to manage their feelings and emotions.  

5.    Self-Perception:  This dimension describes how a person perceives and thinks about themselves.

Millon's Characteristics of a healthy Personality:   Millon describes the essential characteristics of a person with a normal or healthy personality.  These characteristics are:  

1.    Autonomy:  The capacity to function autonomously and independently.

2.    Inadaptability:  The ability to adapt to one's social environment effectively and efficiently;

3.    Emotional Stability:  The ability to maintain a general attitude of acceptance, contentment, and satisfaction in spite of stressors in the environment;  

4.    Self-actualization:  The ability to actively pursue activities that allow them to grow, develop, and achieve their personal potential.

Millon's Concept of Healthy Personality Styles:  Millon sees these four  characteristics of a healthy personality being expressed in eight normal or healthy personality styles:  

1.    Forceful Personality:  This is a person who tends to be adventurous, intimidating, subjective, angry, and assertive.  

2.   Confident Personality:  This is a person who tends to be poised, unempathic, imaginative, serene, and confident.  

3.    Sociable Personality:  This is a person who tends to be animated, demonstrative, superficial, dramatic, and charming.

4.    Cooperative Personality:  This is a person who tends to be docile, compliant, open, tender, and weak.

5.    Sensitive Personality:  This is a person who tends to be erratic, unpredictable, divergent, pessimistic, and unappreciated.  

6.    Respectful Personality:   This is a person who tends to be organized, polite, circumspect, restrained, and reliable.

7.    Inhibited Personality:  This is a person who tends to be watchful, shy, preoccupied, uneasy, and lonely.

8.    Introversive Personality:  This is a person who tends to be passive, unobtrusive, vague, bland, and passive.

Millon's Concept of Personality Disorders:

<To Be Continued>

Pulling It All Together

As a result of studying the different models of personality I developed a model for thinking about personality in relationship to substance abuse and addiction.  Here's the major points of this model

1.    The Concept of Personality:  The concept of personality was developed to answer a basic question:  "Why do people behave the way that they do.  The notion of personality offers a way of thinking that allows us to organize and relate different kinds of behaviors that people engage in and begin to understand the mechanisms within the individual that tend to create and maintain those forms of behavior.

2.    Temperament:  Temperament is "a biologically determined subset of behavior that results in a distinctive pattern response dispositions and sensitivities." In other words. children are born with a temperament that provides a set of tendencies to behave or not behave in certain ways.  A person's temperament will make it easier to initiate and maintain certain forms of behavior and more difficult to initiate and maintain other forms behavior.  Temperament also tends to activate different brain chemistry reactions that can produce pleasure, pain, or no noticeable difference.  As a result, the temperament of a child creates a tendency to behave in certain ways and not to behave in others.  A person's temperament influences what they do, it does not control what they do.  

3     Social Response:  As children grow and develop they begin to experiment with a wide variety of behaviors.  Each type of behavior is reinforced either positively or negatively or it is ignored (not reinforced).  As the child develops the capacity to think and use language they tend to think about and describe three kinds of behaviors:

(1)  Good Behaviors:  Infants tends to intuitively identify positively reinforced behaviors as "good" because these behaviors produce a pleasurable or desired result.  In other words, positively reinforced behaviors are perceived as having pay value because children learn that using these behaviors feels good and allows them to get something they need or want by using these behaviors.

(2)   Bad Behaviors:  Infants tends to intuitively identify negatively reinforced behaviors as "bad" because these behaviors produce a pain or discomfort and do not produce the desired result.  In other words, negatively reinforced behaviors are perceived as having threat value because  children learn that using these behaviors feels bad and doesn't get them what they need or want.

(3)   Irrelevant Behaviors:  Infants tends to intuitively identify behaviors that are ignored, i.e. receive no positive or negative reinforcement, as irrelevant because they don't produce feelings of pleasure or pain and they don't effect their ability to .  In other words, non- reinforced behaviors are perceived as having no value because children learn that using these behaviors doesn't effect how they feel and has no impact on getting get what they need or want or want from other people. 

4.    Two Factors That Shape Personality:  There are two key or critical factors that shape behavior:  The temperament of the individual which tends to make certain behavior more or less difficult to use and activate different reactions in brain chemistry that can produce pleasure, pain, or no significant response; and social response which can reinforce the behavior positively by rewarding it or negatively by punishing it or not reinforcing it at all by ignoring it.  

5.    Habit Formation:  The brain is a habit forming computer.  Any behavior that is in engaged in repeated becomes habituated.  We get in the habit of doing it automatically without having to think about it.  We start using an habitual behavior when an internal or external cue active the automatic habitual response.  Internal cues can be sensory perceptions, thoughts, feelings, or images.  External cues can be anything that happens around us that we notice or perceive.  So we notice something that activates an automatic way of thinking, feeling, and behaving.  These automatic thoughts feelings and behaviors can be acted automatically without a person consciously thinking about it.  In other words, habits allow us to act things out before we can think them through.  Every action creates an internal response mediated by brain chemistry, thoughts, and emotional reactions and by the nature of social reinforcement.  

6.    Personality Traits:  As a result of the interaction between temperament and social response and the habit forming tendency tendency of the brain all people develop deeply entrenched patterns of automatic and unconscious behaviors.  These become the habits of personality which is often called a personality trait.  

7.    Personality Styles:  People develop a broad range of related personality traits (habits of personality).  The combined picture of all of these related traits is called a personality style. 

8.    Analyzing the Personality Traits:  Each personality trait consists of a network of deeply entrenched habits interrelated habits.  This network of interrelated habits can be described as occur within a progressive system that is composed of:  

A.   Beliefs - what we assume to be true and which of these truths are important in either a good way or a bad way or are irrlelevant to our well being;  

B.   Perceptions - We have a perceptual that has been programmed by repetitive life experiences to lock onto things that have either pay value (we believe to be important in a "good" way), threat value (we believe to be important in a "bad" way).  Our perceptual system tend to block out things that our belief system defines as irrelevant. 

C.   Thoughts:  We tend to think about the things that we perceive.  We have a strong tendency to search for evidence that prove our beliefs about the "rightness" or the "wrongness" what we perceive is right, true, and proper.  As a result we tend to think about certain things over and over again drawing the same conclusions from pour thought process.  We call these repetitive conclusion personal "truth" (the truth as I see it) and the the law of habit formation kicks in and we automatically and unconsciously run these thoughts through our mind without consciously noticing it.

D.    Feelings:  Our thoughts affect how we feel.  So we tend to experience similar emotional reactions to certain types of situations in our lives.  As a result we develop consistent ways of responding emotionally.  These consistent patterns of emotional responses create an over-riding mood.

E.    Urge:  We experience a motivating or inhibiting urge.  In other words we feel the urge to do certain things and and the urge not to do other things.  These urges are the logical consequences of our our beliefs, perceptions, thoughts, and feelings which in turn were influenced or shaped by our temperament and types of social reinforcement.

F.   Actions:  We always act in response to urge urge.  We will either act out the urge by doing what we feel like doing or we inhibit the urge by6 refusing to do what we feel like doing.  

G.   Social Reactions:  What we do and don't do always has a social impact.  People react or respond to the behavior by either reinforcing positively or negatively or failing to reinforce it at all by ignoring it.  These social reactions tend to reinforce or challenge the beliefs and perceptions.  Socially reactions that are consistently reinforced leave habitual behaviors unchanged and often reinforce them in a way that makes them stronger and more difficult to change.

CENAPS Biopsychosocial Continuum:  The CENAPS Model describes the Biopsychosocial continuum using four distinct levels:  

1.    Thinking:  This dimension describes how a person organizes their thinking and decision making rules that guide the conduct of the day-to-day living.  This dimension relates directly to Millon's Cognitive Style as described below.  

2.    Feeling:  This dimension describes how a person organizes themselves to manage their feelings and emotions.  This dimension relates directly to Millon's Cognitive Style as described below.  

3.    Behavior:  This dimension describes what a person does and how they behave in ways that can be observed by other people.  In the CENAPS Model the behavioral dimension is broken down into two specific components:

A.    Urges:  What a person wants to do or feels and urge to do.

B.    Actions:  What a person actually does.

C.    Behavior Management:  People learn two vital skills that are used to manage or respond to urges and determine what action to take in response to an urge.  These two skills are: 

(1)   Impulse Control:  Learning stop yourself from acting out a self-defeating or self-destructive urges.

(2)   Self-Motivation: Learning how to make yourself want to or willing to do things that are constructive or self-enhancing even when it is difficult to do so.  

4.    Social Reactions:  This dimension describes how other people typically respond to the way a person behaves.

<To Be Continued>


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