Before we can talk about personality disorders we have to define what a “personality trait” and a “personality” are. A personality trait is an established and enduring way of thinking about and of relating to the world around you. For example, a person who always looks at the downside of things has a pessimistic personality trait whereas a person who “sees the world through rose colored glasses,” to use the old cliché, has an optimistic personality trait. The combination of your personality traits = your personality. A person meets the criteria for having a personality disorder when they have personality traits (enduring ways of thinking about and relating to the world) that are dysfunctional enough to cause an impairment in their functioning in day-to-day life. A person who has weird personality traits, aka: eccentricities, only meets the clinical threshold for having a personality disorder when those personality traits actually start affecting how they relate to the world/people around them in a negative way.
Personality disorders come in three “flavors” or clusters: Clusters A, B, and C. People with Cluster A personality disorders tend to be “weird”: think of a heavily bearded hermit who lives in a cave (schizoid personality disorder), Willy Wonka from Charlie and the Chocolate Factory (schizotypal personality disorder), or the UFO abduction theory fanatics (paranoid personality disorder). People with Cluster C personality disorders are extreme worriers, pathologically clingy people, or pathologically anal retentive persons (avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder, respectively – note that obsessive-compulsive personality disorder is a completely separate disorder from OCD, they just have similar names). Okay, so that leaves Cluster B personality disorders, which is what we’re going to discuss today.
I personally refer to Cluster B personality disorders as the “predatory personality disorders,” but that’s just my personal terminology and not a widely accepted medical term. With that said, by the end of this article I think that you’ll agree with me. The classic Cluster B personality disorders are: antisocial personality disorder (aka: sociopaths, aka: psychopaths), borderline personality disorder, and narcissistic personality disorder. Some people also group histrionic personality disorder, which is a pretty self-explanatory disorder (they’re EXTREMELY histrionic, duh), but I’m not so sure that these folks really belong in the same category as the three classic Cluster B’s so let’s forget about them for now. One quick word on a common misconception before we delve any deeper: antisocial (sociopathic) does not = asocial (a loner who doesn’t like to associate with people – a Cluster A personality disorder).
Antisocial personality disorder classically presents as a criminal who takes advantage of other people, violating their rights and their personhood without remorse. Not surprisingly our prisons are full of sociopaths. Unlike the common perception of the “cold psychopath,” most people with antisocial personality disorder are extremely likable – this is what allows them to get close enough to people to take advantage of them and it is also what allows sociopaths to often get away with their crimes after they have been caught. Sociopaths have zero empathy for other people. When you see courtroom videos of people who have committed horrific crimes and then get enraged when they are sent to prison, guess what?, the reason the criminal is angry is because they really don’t believe that they did anything wrong. Other people are just objects of opportunity for someone with antisocial personality disorder. Don’t ever ask yourself “how could someone do that to another person?” when you’re dealing with a sociopath – taking advantage and abusing another person is the same in the mind of a sociopath as pounding the pavement with a pair of running shoes or wiping your feet off on a floor mat is to you.
Not all sociopaths end up in prison. High functioning sociopaths can and do integrate themselves into life, taking advantage of people and using their superior social skills of manipulation to keep out of trouble. Ariel Castro was a good example of a high functioning sociopath for over a decade, keeping girls/women as sex slaves in his home while working as a school bus driver. Ariel Castro’s extreme sexual sadism may also make him a good candidate for “sadistic personality disorder,” which is currently a topic of research and not an official medical diagnosis. Regardless, there is no doubt in my mind that he has antisocial personality disorder, a psychopathology for which there is no effective treatment (penitentiary “therapy” is society’s current way of “treating” these predators). Antisocial personality disorder generally starts off as “conduct disorder” in childhood and a history of torturing animals is a major red flag that a child may grow up to become a sociopath. The good news about sociopaths is that they tend to mellow with age – a raging sociopath at age 20 has a reasonably decent chance of “burning out” and becoming a more decent person in their 50s or 60s. Most sociopaths are males and, interestingly, being born with an extra Y chromosome (XYY instead of the normal XY) is a risk factor for developing this disorder – however, most sociopaths do not have an extra Y chromosome.
Narcissistic Personality disorder is to antisocial personality disorder as Bud Light is to Budweiser – most narcissists have some sociopathic traits and most sociopaths have some narcissistic traits so the two disorders are really a spectrum of a single dysfunction. Narcissists have an inferiority complex and they compensate for this by acting grandiose and by being self-absorbed. Like sociopaths, narcissists are charming and they have no empathy for other people, viewing others as objects to be used and to be manipulated. People with narcissistic personality disorder often select careers in which their future subordinates will have to treat them in a deferential, god-like manner. Narcissists feel right at home in the military (Yes, Sir! Right away, Sir!) and the profession of surgery is notorious for attracting narcissists into its ranks (think of a surgeon cursing at his operating room staff and throwing things at them – that doesn’t just occur in the world of fiction!).
Like narcissists, people with borderline personality disorder also usually have sociopathic traits. Whereas Cluster B (predatory) personality traits typically present in men as narcissism or as full blown sociopathy, the female manifestation is more typically borderline personality disorder. Like narcissists and sociopaths, borderlines have zero empathy for other people, are charming, and manipulate people (to them people = objects) to get what they want. The core pathology at the heart of borderline personality disorder is believed to be an EXTREME fear of rejection. Borderlines suck people into close relationships then start manipulating and abusing these people. The unfortunates who find themselves trapped in a relationship with a borderline are in for a rocky ride, to say the least! Borderlines engage in splitting behavior in which they see people as either angelically “good” or demonically “bad,” with no gray area in between. While new lovers start out in the “good” category, they always eventually let the borderline down in some way or another and end up in the “bad” category. And that’s when the abuse starts. So now the unfortunate target of the borderline is in a relationship with someone who hates them but who also refuses to let them go because they’re intensely afraid of abandonment.
Borderlines keep the people they are abusing in their lives by performing self-mutilation and suicidal gestures to “punish” their significant others, to get people to feel sorry for them, and to essentially force their victims to come back to them (“if you leave I’m going to kill myself!”) — sometimes borderlines screw up their suicidal gestures and accidentally really do commit suicide. In my opinion, and this is just from watching TV like the rest of you, Jodi Arias is a particularly nasty borderline who was so furious about being “abandoned” by her boyfriend that she killed him. Notice how manipulative Arias was (or attempted to be) on the witness stand and in her interviews with the press – classic borderline behavior. I actually was the witness to a murder, a murder that was discovered two hours before I was scheduled to get on the plane to begin my deployment to Iraq (talk about a lousy day), committed by a borderline who was enraged at her boyfriend for attempting to break off the relationship. She gunned him down and then killed herself and I got to listen to it happen. I also grew up in the house of an ‘off of the charts’ borderline who was also a sadistic child abuser. If you happen to be interested click on the book cover to “Intrusive Memory” to your right – I have to warn you that unless you grew up in Rwanda or Bosnia this book will probably disturb the hell out of you.
Jodi Arias and Ariel Castro are examples of an exceptionally cruel borderline and sociopath, respectively. Most borderlines would never think of murdering their significant others, instead contenting themselves with manipulating them and often with abusing their children. Similarly, most sociopathic gang members have no problem robbing people and occasionally murdering them but wouldn’t stoop to the level of enslaving girls in their basement. Borderline personality disorder may be treatable to a degree with intensive counseling but the verdict on this is very much still out. Most borderlines are functional people who live and work right alongside the rest of us – the “good news” being that most of their predatory behavior is usually directed at intimate family members and not at acquaintances, although there definitely are exceptions to this loose rule. Sociopaths and narcissists also live alongside us and they do not tend to discriminate, victimizing whoever is convenient. Be careful who you trust and seek help from the authorities, an attorney, or both if a predator is preying on you. It is, sadly, a dangerous world.
LEGAL DISCLAIMER: Ariel Castro is accused of the crimes described above but he has not been convicted in a court of law. Mr. Castro has pled “not guilty” to above said crimes and he is not guilty until convicted under the laws of The United States of America and the State of Ohio. Ms. Arias has been found guilty of murdering her former boyfriend, Travis Alexander. This article is not based on a medical evaluation of Mr. Castro or Ms. Arias and no doctor-patient relationship exists or is implied as existing between Dr. Noto (nom de plume) or either of the above said persons. Dr. Noto’s views are his own and they are presented for entertainment purposes only on www.leonardonoto.com. Dr. Noto’s views, as expressed on www.leonardonoto.com, do not necessarily reflect the views of any of his employers, past or present.
Dr. Leonardo Noto
Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis –> (Click on the book covers on the right to check out my books!).
Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 12-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).
Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.com is intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!