Are You Puzzled by Personality Disorders?

Everyone seems to be talking about personality disorders. Suddenly, diagnostic terms like narcissistic, borderline, or schizoid are being thrown around like confetti. Many people are finding this very confusing and wondering: How do I recognize someone who is narcissistic? How do narcissists differ from people who are borderline or schizoid?

If you are reading this article, you are probably puzzled as well. Fortunately, I have developed a very simple method to help psychotherapists learn to diagnose personality disorders that can be used by non-therapists as well. I call it "The Interpersonal Gestalt." It is not sufficient by itself to give you a complete diagnosis, but it will definitely help point you in the right direction.

What is the Interpersonal Gestalt?

Gestalt is a German term for an organized whole that is more (or different) than the sum of its parts. The Interpersonal Gestalt, or IG for short, is based on the Gestalt psychology theory of figure/ground formation.

This basically states that at any point in time there is more data available to our mind and senses than we can possibly process. In order not to be overwhelmed, we automatically prioritize certain types of data over others. In interpersonal encounters, we tend to notice things that relate to our current desires and fears or past unmet needs and traumas. Traumas from the past appear as fears in the present.

What we notice becomes the figure, and what we ignore becomes part of the unseen background. This is an unconscious process that allows us to form a coherent picture of other people from a set of details.

How does this relate to diagnosis?

We can distinguish which of the three major personality disorders someone is likely to have by paying attention to what the person repeatedly makes foreground or ignores during interpersonal encounters.

Borderline IG: People with borderline issues tend to notice interpersonal data that relates to their unmet needs for love, nurturing, and reparenting or their fears of abandonment or engulfment by the emotional needs of the other person.

Narcissistic IG: People with narcissistic issues tend to notice interpersonal data that relates to validation, self-esteem, social status, or the possibility of being exposed as worthless or publicly shamed.

Schizoid IG: People with schizoid issues tend to focus on interpersonal data that relates to their desire for interpersonal safety and personal autonomy or that stimulates their fears of being intruded upon, controlled, or losing the ability to connect.

As you can see from the above examples, we can specify the difference between these three personality disorders in terms of their core desires and fears. These different priorities can be observed during one-on-one interactions.

Let’s look at how this method of diagnosis might play out during a first session, based on what three different clients makes figural about me and my office. These are abbreviated snippets of actual sessions with clients.

Example—Emma the Status Evaluator

My new client Emma shows up for her first session. She is very well-groomed and wearing designer clothing. She looks around the room and appears to be sizing it up. She sits down facing my wall of diplomas. Very impressive, she says. Then she turns and looks at my floor-to-ceiling bookcase. How many of them have you actually read? I say: About one third of them. I use them for references on an as-needed basis.

Emma nods, as if my answer meets with her approval. Then she asks: This office is very nice. Do you rent or…..?”

It is obvious to me that Emma wants to know how to evaluate me—where I stand financially. If I own the office, that would give me more status than if I am merely renting. When I tell her that I own the whole townhouse, Emma settles down and we begin the session.

I feel as if I have just passed a series of tests about my intelligence, credentials, wealth, and status.

So, what was figural for Emma?

This brief snippet is too short to give Emma a definitive diagnosis, but we can get important information from what she found interesting and remarked on. As Emma was wearing high-status clothing and noticed things that seemed to indicate my professional, intellectual, and personal social status, such as my diplomas, books, and whether I owned the office or rented, we could summarize her interests as mainly involving my status and whether she could respect me. These are typically narcissistic concerns.

Example—Ben and Seating

My new client Ben rings my bell exactly on time. He comes in and asks: Where should I sit? I tell him where I will be sitting and that he can sit anywhere else that he likes. Once I sit down, he sits down in the chair closest to the door on my right. He appears visibly nervous. I ask him: What brings you here today?

He hesitates and then says: I am very uncomfortable at work. They changed my office and now I am sitting in an open area. I have no privacy and no control over my space. Anyone can approach me and start talking anytime they want. This is my worst nightmare.

Based on his nervousness and what he has just told me, I ask Ben: How are you feeling here about where you are sitting in relation to me? Are you where you want to be? Is there some place in this room that would be more comfortable for you?

Ben hesitates and finally says: Thank you for asking. I am not sure how to answer. No one has ever asked me about my seating preferences before or even checked that I was okay! I realize that I like that you sat down first. I like knowing where other people are. I like things to be predictable. I also like that you gave me a choice of seats. I chose the one to your right because It was nearest the door. (Ben gives a nervous laugh). That way I can run out of here quickly, if I want to leave.

So, what was figural for Ben?

Ben was focused on issues that had to do with privacy, barriers to intrusiveness, physical proximity, and the ability to quickly escape an interpersonal situation. These are all typically schizoid concerns.

Example—Suzi and the Sofa

Suzi came for her first session 10 minutes late. She was very, very apologetic. I found myself reassuring her that I was not angry. I invited her to sit and she went to the velvet sofa to my right that had soft pillows and a granny afghan. She asked if it was okay to take her shoes off. When I said “yes,” she curled up with a pillow and put her feet up on the sofa.

Suzi said: This is such a beautiful office. It is so warm and inviting. The afghan kind of reminds me of my Granny. I loved her so much. As a kid, I loved going to visit her. She was like a magical person. Her house was filled with all sorts of things that grownups collect, but she let me play with anything I wanted. She always had my favorite foods. You remind me of her. You are so nice. I am already comfortable here with you.”

So, what was figural for Suzi?

Suzi wanted me to like her and had quickly bonded with me. She attributed warm and loving characteristics to me. She needed a lot of reassurance, and tended to notice things that signaled interpersonal warmth, such as my sofa, my afghan, my smile, and my similarity to someone who had unconditionally loved her.

Using the Interpersonal Gestalt as a beginning place to start diagnosing the person:

Obviously, I do not have enough information here to make a diagnosis. But paying close attention to what Emma, Ben, and Suzi each made figural (and what they did not) during our first meeting makes it clear that they have very different issues and are likely to have very different diagnoses.

Emma and Status—Emma’s focus on aspects of the room that relate to status and her cool evaluation of me, suggests that, if she turns out to have a personality disorder, it is likely to be a narcissistic one.

Ben and Interpersonal Distance—Ben made it clear that he felt unsafe when he could not control other people’s physical access to him. This is a common concern that is expressed by almost all my schizoid clients.

Suzi and Her Granny—Suzi had none of Ben’s hesitations about closeness and seemed unconcerned with the status indicators that preoccupied Emma. Instead Suzi focused on things that relate to warmth, love, and coziness. I reminded her of her loving granny, and she reminded me of my four-year-old grandchild—who also likes to curl up on my sofa without her shoes, wrapped in the afghan, with her head on a mound of pillows.

Conclusion

The Interpersonal Gestalt gives us a simple way to begin to recognize and differentiate borderline, narcissistic, and schizoid issues. All we need to do is pay close attention to the interpersonal data that the person we are observing finds meaningful. If it primarily involves status and achievement, the person is likely to have narcissistic issues. If the data involves interpersonal safety and autonomy, the person is likely to have schizoid issues. And, if the person primarily notices signs of warmth, approval, and love, borderline issues are likely.

Adapted from a Quora article.