By Terence T. Gorski
April 13, 2002
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
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,
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
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
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
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 Personality. I 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
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
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
Millon's Biopsychosocial Continuum: Millon describes the
biopsychosocial continuum using five distinct levels or dimensions:
Appearance: This dimension describes what a person does and
how they behave in ways that can be observed by other people.
Conduct: This dimension describes how a person typically
related to other people.
Style: This dimension describes how a person organizes their
thinking and decision making rules that guide the conduct of the
Expression: This dimension describes how a person organizes
themselves to manage their feelings and emotions.
This dimension describes how a person perceives and thinks about
Millon's Characteristics of
a healthy Personality: Millon describes the essential characteristics
of a person with a normal or healthy personality. These
The capacity to function autonomously and independently.
The ability to adapt to one's social environment effectively and
Stability: The ability to maintain a general attitude of
acceptance, contentment, and satisfaction in spite of stressors in the
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: This is a person who tends to be adventurous,
intimidating, subjective, angry, and assertive.
Personality: This is a person who tends to be poised,
unempathic, imaginative, serene, and confident.
Personality: This is a person who tends to be animated, demonstrative,
superficial, dramatic, and charming.
Personality: This is a person who tends to be docile,
compliant, open, tender, and weak.
Personality: This is a person who tends to be erratic,
unpredictable, divergent, pessimistic, and unappreciated.
Personality: This is a person who tends to be organized,
polite, circumspect, restrained, and reliable.
Personality: This is a person who tends to be watchful, shy,
preoccupied, uneasy, and lonely.
Personality: This is a person who tends to be passive,
unobtrusive, vague, bland, and passive.
Millon's Concept of
<To Be Continued>
Pulling It All
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
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
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.
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:
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.
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.
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
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.
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.
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.
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.
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:
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
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
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
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.
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.
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.
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
CENAPS Biopsychosocial Continuum: The CENAPS Model
describes the Biopsychosocial continuum using four distinct
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.
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.
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:
What a person wants to do or feels and urge to do.
What a person actually does.
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:
Control: Learning stop yourself from acting out a self-defeating
or self-destructive urges.
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
Reactions: This dimension describes how other people typically
respond to the way a person behaves.