Abnormal Personality

¹ Senior Lecturer, Edinburgh University Department of Psychiatry, Morningside Park, Edinburgh 10
² Medical Research Council Unit for Reesarch on the Epidemiology of Psychiatric Illness, Edinburgh University Department of Psychiatry, Morningside Park, Edinburgh 10
³ Lecturer, Edinburgh University Department of Psychiatry, Morningside Park, Edinburgh 10
⁴ Senior Clinical Psychologist, Professorial Unit, Royal Edinburgh Hospital, Morningside Park, Edinburgh 10

Part 1

1. This preliminary study of the clinical presentation of abnormal personality shows that psychiatrists more reliably categorize patients in descriptive terms than by use of diagnostic terminology. They do not agree about the nosological label to be applied to an individual patient's personality, but show better agreement in categorizing selected aspects of the patient's behaviour.

2. The considerable variation among psychiatrists in their use of the diagnostic classification occurred in spite of their regular working contact and their frequent discussions about the system of classification. The lack of reliability may be improved by more thorough briefing of the raters about diagnostic terms, or by ensuring that all clinicians have the same amount of personal knowledge about individual patients, which was known not to be the case in the present investigation.

Part 2

The investigation differentiates four types of abnormal personality, which may be designated as follows:

Type 1. Inhibited personalities: The patients have disturbed personal relationships and difficulty in fitting in socially. They are anxious and guilty and do not act aggressively. They have marked assets of personality, sociopathic features being absent.

Typ 2. Personality disorders: These patients have more marked disturbance in interpersonal relationships and grosser difficulty in adapting socially. Their main feature is their dependency. They fail to meet obligations, not because they are antisocial but because they are self-absorbed and lacking in aggression. They tend to present clinically as hysterical disorder in the case of women, and as schizoid or obsessional personality disorder in the case of men.

Type 3. Aggressive sociopathy: These patients are unlikeable, antisocial, highly impulsive, and aggressive.

Type 4. Inadequate sociopathy with addiction: These patients are dependent on drugs or alcohol, and are grossly egocentric; they evade obligations, lack regard for the consequences of their actions, and are free of guilt or anxiety.

The four types support the major categories of the original classification set out in Part 1 (i.e. the severity dimension), but descriptive labels were not reliably applied. There are important sex distinctions among the types, e.g. Type 2 males present when grossly ill, often with psychoses, while the equivalent type in women present clinically without serious illness but with major social complications. Type 3 men are guilt-free, but an aggressive sociopathic state in women is accompanied by anxiety and self-blame; the Type 3 male, moreover, may show sexually deviant behaviour, but this is not a feature of the women in that category.

One of the preliminaries to further exploration of the clinical manifestations of personality disorder is a clearer definition of hysterical disorder in women. On the basis of the present study we suggest that this personality diagnosis can usefully be confined to women whose relationships are grossly disturbed and who are both egocentric and also passive and dependent; the term loses its discriminating value when applied to women who are aggressive and antisocial.

These findings are derived from a relatively small sample of patients, and one moreover which is not representative of abnormal personalities in general. The results are being tested further in an investigation now in progress.