Generally speaking, traits may be either adaptive, as the trait of ambitious competitiveness can be, or maladaptive, as are the traits of lack of self-assurance and masochistic self-destructiveness. Personality traits are not inherently either normal or pathological. This is so because legitimate individual personality differences exist, with some people normally more introverted than others, and such different personalities as uncomplicated Type A and Type B personalities both within the normal range. Also, in determining the presence of normalcy versus psychopathology, external circumstances have to be taken into account. Thus a trait that is pathological under some cultural and environmental circumstances is nonpathological under others, for example, on vacation or at a special time of the year, with such terms as winter doldrums reminding us that we as individuals, and society as a whole, often make cultural allowances for some deviation from year-round norms.
Personality Disorder
In exceptional cases, a personality disorder can consist of the use of one favored trait employed either only under certain circumstances or continuously. The former is exemplified by dissociation that only occurs in the face of “acceptance emergencies,” or “projection” that only occurs under extreme stress and is meant to create a resolutely “not-me” excuse to avoid feeling guilty about one’s unacceptable thoughts and actions. Generally, however, a personality disorder is made up of multiple traits. These tend to be selected on the basis of affinity with each other, for example, shyness and submission or withholding and withdrawing. Also, unless the traits selected are inherently distinctive, and, if multiple, combined in a unique way, personality style, not personality disorder, will result. In the realm of “inherently distinctive,” the traits that constitute a personality disorder are generally abrasive and pungent, with negative traits favored over positive traits, so that Mr. Lowdown predominates over Mr. Loveable and maladaptive traits are favored over adaptive traits. In the realm of “combined in a unique way,” unless there is a critical mass of traits that additionally syner-gistically distort the personality, we will not have a personality disorder, but a pattern less dramatic in presentation, startling in nature, and devastating in effect than a true syndrome needs to be. Put another way, unless the resulting psychological construct makes waves, ruffles feathers (one’s own and others), and attracts psychiatric attention because the individual, for any one of a number of reasons, develops difficulties that are sufficiently overt to be obvious, and sufficiently intense to become noticeable, that is, unless there are discrete, obvious, and generally troublesome interpersonal/social behavioral consequences, the diagnosis of a personality “style” or “type,” rather than a “personality disorder,” should be considered.
In the realm of comorbidity, many, if not most, avoidants do not exhibit avoidant personality traits or disorder alone. AvPD is commonly not diagnosed by itself; rather, AvPD is often part of a complex syndrome characterized by more than one personality disorder, the elusive “pure singular syndrome” rarely ruling in a given individual. In great measure, this is because the individual component traits of AvPD are not distinctive enough to suggest only one diagnosis so that, for example, the trait of withdrawal can also be schizoid or phobic, leading the diagnostician to call the withdrawn individual a “mixed avoidant/schizoid” or to say that he or she is suffering from a personality disorder “best described as avoidance due to a social phobia generalizing.” Like many personality disorders, AvPD is a somewhat elusive entity due to being made up of traits that are in themselves undistinguished and assembled into a tentative and shifting psychological edifice, rough in outline and construction, that is less a firm unvarying entity than a proclivity to move in a certain direction, in this case, anxious withdrawal, as distinct, for example, from suspicious remoteness.
Conversely, only a few personality disorders have a relatively hard-edged identity: the obsessive-compulsive and the paranoid representing two exceptions.
A caveat is that a personality disordered label cannot be attached to an individual unless an experienced clinician has seen the patient in person, carefully studied him or her over a significant period of time, and determined if overall behavior, not just one or two examples of it taken out of, or even in, context, warrants that such a determination be made.
CHAPTER 4 Sexual Avoidance
There are two broad categories of sexual avoidance: innate or essential (asexuality) and acquired (anxious).
DESCRIPTION
Innate or Essential Sexual Avoidance (Asexuality)
Innate or essential sexual avoidants suffer from a sexual hypoactiv-ity disorder, a kind of “sexual alexithymia” where the individual experiences diminished or absent sexual urges and believes that that state of affairs is normal, welcome, desirable, and acceptable. The cry is, “I don’t feel sexual, I don’t want to feel sexual, I just can’t have sex, I won’t have sex, who needs sex, sex is not for me.” Some asexual men and women complain only of a lack of desire, while others also complain of a lack of genital sensation. Some once felt sexual but lost that feeling later in life. Others claim that they had nothing to lose because they never had strong sexual feelings in the first place. Some retain the capacity for romance. Others are as personally unromantic as they are sexually unarousable.
A Case Example
One of my asexual patients half-jokingly said that he was “perfectly happy being in love with his truck.” He cracked that he was so in love with her that he had fallen in love with her “head over wheels.” He spoke of how sad he was to have to let his truck go now that he bought a newer, younger girl, for his truck was a faithful companion, but getting on in years. She had 315,000 miles on her and had been with him for a decade. If he sold her, he couldn’t get much money for her because of all her mileage. But the person who bought her would be getting a great little woman because she was still in very good shape and in a position to serve. True, not all of her anatomy was still intact, but anything anyone needed was still there, and she could still do everything important she needed to do, and do it as well as any girl half her age.
This man had had sex with his wife a few times in the beginning of their marriage. After they produced a child, he started thinking that sex was evil, so to get away from his wife’s sexual advances, he built her a separate house attached to the main dwelling so that they could live together, yet apart, and go their separate ways: she to France to have a series of affairs, and he to his job, driving his beloved truck by day and even sleeping in her at night.
On those rare occasions when his wife still approached him for sex, he would tell her in essence, “We did it already—we had a kid; why do we have to do it again?” He would then make the following excuses as he went off to sleep by himself:
• I can’t sleep with you in the same bed; you snore and toss and turn.
• You don’t keep yourself up.
• You are too old.
• I am too old.
• It’s the same thing over and over again.
• The kid will overhear us.
• Every time I do it, I get irritated down there.
In passing, he also noted that not only his sexuality, but also all his biological functions were slow—so slow, indeed, that he only had a bowel movement once a week. Then he added that anyway, for companionship, he was content with his 20 cats, each of which had a special personality, which he would then go on to describe in detail as if he were talking about 20 parts of a wife, split among 20 different souls. This one purred when he stroked her, that one slept with him, this one kissed him good night, that one woke him up in the morning, this one gave him the feeling that he was wanted, and so on.