psy 615

psy615week2assignmentarticledownload.pdf

Evolution of Millon’s Personality Prototypes

James P. Choca School of Psychology Roosevelt University

In 1969, Millon proposed 8 personality prototypes that could be conceptualized at lower levels of severity than the level of the personality disorders. These personalities were fit into a theoretical system that emphasized the strength of the interpersonal at- tachment and the mode of accommodation. Disorders such as schizophrenia and de- pression were pictured as a decompensation of the basic personality. This article traces the evolution of Millon’s theory from the original inception, through the influence of the 3rd and 4th editions of theDiagnostic and Statistical Manual of Mental Disorders, and onto its present form. Now visualized as resulting from 3 polarities, the model has expanded the number of personalities to include 3 additional prototypes.

Through a book entitledModern Psychopathology(1969),Theodore Millon pro- posed a new classification for emotional or psychiatric disorders. The foundation of the system was made up of eight personality prototypes borrowed from the psychi- atric nosology that was current at the time, the second edition of theDiagnostic and Statistical Manual of Mental Disorders(DSM–II; American Psychiatric Associa- tion, 1952). The innovation was the way Millon described and conceptualized the eight prototypes in the 1969 book and in another book that followed shortly thereaf- ter (Millon & Millon, 1974).

First, Millon (1969) wrote less pathological versions of personality disorders of theDSM–II,creating “personality patterns of mild severity” (p. 220). In each case, he set his descriptions to characterize three elements for each of the eight personal- ity patterns: behaviors, self-perceptions, and intrapsychic processes.

Second, Millon fit his personality prototypes into a logical and coherent clas- sification scheme. To organize the eight personality prototypes, Millon focused on the kind of interpersonal relationships that the individual typically established and the mode with which the person achieved his or her accommodation with

FIGURE 1 Organizational scheme for the personality prototypes proposed in 1969.Note:The schizoid personality was labeledasocialin the original work; this label was changed to the cur- rent label ofschizoidto avoid confusion.

354

the environment. As Figure 1 shows, Millon used the tendency toward interper- sonal attachment or dominance to produce four different options (left column of the figure). Two modes of accommodation (active and passive) were added to each of the interpersonal choices to create the basis for the eight personality prototypes.

Although the concept of interpersonal styles is easily understood, the concept of the modes of adaptation is more elusive and merits an additional explanation. Adaptation to the environment can be seen as a process of changing those aspects we can change and accepting those aspects we cannot change. Millon proposed that individuals have a natural tendency toward one or the other of these two modes of adaptation. The proclivity of the personalities with theactivemode is to attempt a change of the environment, whereas the inclination of thepassiveper- sonalities is to adjust to the realities of the environment without change.

The reasons why different personalities use a particular mode of adaptation dif- fer. The passive mode of the dependent personality, for instance, results from an individuals’s belief that he or she is inferior and would not be personally able to make any significant changes in his or her environment. The passive mode of the narcissistic personality comes from the opposite belief, the conviction that he or she is so special that the individual does not need to make the effort it takes to alter the environment. The active mode of the histrionic personality is generated by the need to obtain attention from others, whereas the active mode of the antisocial is tied to the assumption that the world is a competitive setting where no one is totally trustworthy (Millon, 1995).

The third major innovation proposed by Millon in 1969 was the expansion of the eight basic personalities to take into account the level of dysfunction or se- verity. Millon believed that as the severity of the symptomatology increases, the distinctive flavor of the different personality styles is attenuated. As a result of this process, the distinction between the active and the passive mode becomes blurred, and the clinical picture of individuals with different personalities be- comes less unique. Figure 2 shows this process in graphic form. The theory ex- plained schizophrenia, bipolar affective disorder, and the paranoid delusional syndrome asdecompensationsof the individual’s personality structure. These disorders were seen, as a result, as severe personality disorders. In other words, at the milder level, the inability to establish a relationship with others leads to a schizoid or avoidant personality. More extreme cases become more peculiar and fit the description of the schizotypal personality. When the breakdown of inter- personal relationships is further exacerbated, the person develops the more se- vere psychopathology of schizophrenia or the complete dysfunction referred to by Millon as the terminal personality. The application of the same idea to the other styles led to the cycloid and paranoid personalities, as well as the cyclo- phrenic and the paraphrenic.

PERSONALITY PROTOTYPES 355

For the sake of completion it should be mentioned that, in addition to the person- ality disorders, Millon proposed three other groups of disorders in his classification system. Thesymptom disordersincluded anxiety, psychophysiologic, sociopathic, and psychotic disorders. Underpathological behavior reactions,Millon recognized transient situational reactions and circumscribed learned reactions. Finally, Millon used the label ofbiophysical defectsto cluster disorders that are a direct result of brain dysfunction.

During the decade that followed the publication of his book, Millon was influential in the development of a new psychiatric classification system, the groundbreaking third edition of theDiagnostic and Statistical Manual of Mental Disorders(DSM–III; American Psychiatric Association, 1980). Although there were some differences be- tween the Millon personalities and those of theDSM–III (Widiger & Sanderson, 1987; Widiger, Williams, Spitzer, & Frances, 1985), the conceptualizations of the personal- ity prototypes in the two systems were generally compatible. The creation of multiple

356 CHOCA

FIGURE 2 Original model for the decompensation of personality prototypes into more severe personalities.Note:The schizotypal personality was labeledschizoidin the original work; this label was changed to the current label ofschizotypalto avoid confusion.

axes for theDSM–III, with one axis designed to hold the personality makeup of the in- dividual, was loyal to Millon’s separation of personality and other types of psycho- pathology. It is noteworthy, on the other hand, that theDSM–III did not visualize schizophrenia, bipolar affective disorder, or the paranoid delusional disorder as decompensations of the personality.

Continued efforts to improve psychiatric nosology soon led to a revision of the DSM–III. The possibility of including two additional personality disorders, the sa- distic and the masochistic personalities, was widely discussed. These disorders were included in the appendix of the revised nosology, theDiagnostic and Statisti- cal Manual of Mental Disorders(3rd ed., rev. [DSM–III–R]; American Psychiatric Association, 1987). Eventually those disorders were voted down but not before Millon became convinced of the usefulness of the prototypes. To accommodate the new prototypes Millon added adiscordantelement to the detachment and dom- inance that had been used to characterize the different personalities in the previous version of the model. As with the other factors, the discordant element has a pas- sive variant (the masochistic or self-defeating personality) and an active variant (the sadistic or aggressive; Millon, 1987).

In addition to the new prototypes, Millon revised some of his descriptions to in- crease the compatibility between the Millon personalities and those of the DSM–III (Millon, 1987). Most notably, the mood instability of the cycloid person- ality was deemphasized in favor of some of the elements introduced in the DSM–III as part of the borderline personality, such as the impulsive acting out. The name of this particular prototype was also changed toborderline.

Finally, an attempt was made during this period of time to fit all of the Millon prototypes into a circumplex. The resulting circle (Millon, 1987) used two dimen- sions to map all of the personalities. Theaffiliation dimension of they axis offers autonomous and enmeshed as poles; theemotionalitydimension is represented by thex axis with the attributes of impassive and expressive as extremes.

Further development took place when the possibility of adding a depressive personality disorder was discussed in preparation for the next revision of theDSM, the work that led to the fourth edition (DSM–IV; American Psychiatric Associa- tion, 1994). Although the prototype was eventually relinquished to the appendix of theDSM–IVas an entity in need of further study, Millon (1994) liked the concept and added this prototype to his list.

The next milestone in the development of Millon’s (1990) creativity occurred when he expanded his theory to take evolutionary concepts into account. Millon’s use of evolutionary concepts to complement his theory is discussed in another article and goes beyond the scope of this effort. However, the ideas about evolution seem- ingly led him to reformulate the foundation of his personality styles (Millon, 1995).

Millon now uses threepolarities(see Figure 3) to explain the basic differences between his personality prototypes. One of these polarities, theadaptation mode

PERSONALITY PROTOTYPES 357

polarity (active–passive), was already described. Thereplication strategypolarity (self–other) contrasts the drive toward self-actualization with the need to have re- gard for others. Personalities emphasizing the self (the narcissistic and the antiso- cial) are confident and assertive, and seem to have their own ideas on how to conduct their lives. In contrast, the personalities emphasizing others (the depend- ent and the histrionic) rely on other people for meeting their needs and are invested in the welfare of others.

The third polarity is thesurvival aimpolarity, contrasting the pursuit of plea- sure to the avoidance of pain. According to Millon (1995), some personality styles strive to enhance life, seeking new experiences and pursuing pleasure and fulfill- ment. People with these personalities (e.g., narcissistics, histrionics, antisocials) seek more than life preservation. In contrast, other personalities (e.g., avoidant, compulsive) emphasize the avoidance of danger above everything else, even at the expense of constricting their existence.

358 CHOCA

FIGURE 3 Millon personality polarities.

A personality prototype may be strong, weak, or neutral in any particular ele- ment of any of the polarities. Being strong on a particular element of a polarity does not imply a good attribute, but simply indicates a tendency toward some style of behavior.

Using the three sets of polarities, Millon was able to characterize each of the personality prototypes. The schizoid personality, for instance, is strong in the pas- sive polarity but it is weak in the pleasure, the pain, and the other polarity. As Fig- ure 4 illustrates, however, the mapping becomes quite complex. Millon (1995) simplified that complexity by emphasizing the polarity of greatest deficiency in grouping the personality prototypes, as shown in Figure 5.

As in 1969, Millon currently proposes severity as another variable. Borrowing concepts from Kernberg’s (1984) work on personality dysfunction, Millon now dis- cusses the personality structure. The level of severity that was labeledborderlinein 1969 is now referred to as involving adefectivepersonality structure; progressively higher levels of dysfunction are characterized as reflecting adecompensatedor ater- minal personality structure. Figure 6 offers the mapping of the current Millon per- sonalities at the four levels of dysfunction.

Although Millon still feels that personalities can decompensate into a schizo- phrenic-like disorder, now that disorder is labeleddecompensated schizotypalin- stead of schizophrenia. The decompensated disorders can further decay into the terminal disorder, as had been proposed earlier. The idea that personality disorders can evolve into an affective disorder has been abandoned. The other change is the recognition that the avoidant, narcissistic, and antisocial personalities can decom- pensate into a borderline personality disorder (Millon, 1995).

Millon’s personality prototypes have both a categorical and a dimensional na- ture. The dimensional aspect allows us to conceptualize an individual as being

PERSONALITY PROTOTYPES 359

FIGURE 4 Characterization of the Millon personality prototypes in terms of the Millon polar- ities. The chart shows weakness of a priority with a down pointer and strength with an up pointer.

FIGURE 5 Current grouping of Millon personality prototypes.

360

stronger or weaker in any of the categorical dimensions. Thus, even when two per- sons are both histrionic, the two of them may be differentiated if one is more histri- onic than the other. Additionally, real-life people often demonstrate more than one of the personality prototypes. The person who is mostly compulsive but also has avoidant elements will appear noticeably different from the person who combines the compulsive and the negativistic prototypes.

Descriptions of personality profiles that take into account more than one person- ality have been used to interpret the self-report inventories based on Millon’s theory (see Choca & Van Denburg, 1997; Craig, 1993). Using that kind of information, Millon recently expanded his descriptions to characterize subtypes of the different prototypes. Among schizoid individuals, for instance, Millon discusses an affectless schizoid who—in addition to being schizoid—is compulsive, or a remote schizoid who is both schizoid and avoidant. Whether the person is an amorous, unprincipled,

PERSONALITY PROTOTYPES 361

FIGURE 6 Current portrayal of the decompensation of personality prototypes into more se- vere personalities.

or compensatory narcissist depends on whether histrionic, antisocial, or negativistic elements accompany the narcissistic traits. The latest edition of Millon’s (1995) book on personality disorders recognizes 61 such subtypes.

Finally, Millon refined his characterization of the different prototypes intoclin- ical domainsthat address four different levels: the behavioral, phenomenological, intrapsychic, and biophysical levels. Functional and structural aspects may be rec- ognized in any of the four levels. As depicted in Table 1, these clinical domains ad- dress all of the areas required for the characterization of the antisocial prototype.

This article summarized the gains in depth and complexity that the Millon model has made during the 30 years it has been in existence. The addition of evolu- tionary concepts has enriched greatly what the theory had to offer. In achieving that gain, the theory lost some of the simplicity of the original model. The current system of polarities is so intricate that few practitioners may have enough of a command of the system to be able to use the polarities productively. Perhaps that is the fate of any psychological theory as it matures in its attempt to reflect the com- plex intricacies of human nature.

Viewing the developments of the Millon theory from the perspective of theDSM, there are some areas that have gained consonance, whereas other areas seem more divergent. An example of the former has been the abandonment of the idea that affec- tive disorders (the cycloid personality, cyclophrenia) represent dysfunctional as- pects of the personality. On the other hand, Millon’s model has acquired three personality prototypes that are not recognized by the official nosology. It should be obvious, however, that the official nosology is itself unstable and transitional.

As Hirschfeld (1993) eloquently pointed out, there is no way to define what is currently included under Axis II of theDSM.If this axis is eventually defined as containing the lifelong tendencies of the individual, then Millon’s additional pro- totypes and the concept of decompensated personality disorders may very well guide further developments in the field. I would favor including only personality styles on Axis II, prototypes that are commonly seen in a nonpsychiatric popula- tion and that are not, in and of themselves, pathological. If we were to take that di-

362 CHOCA

TABLE 1 Clinical Domains of the Antisocial Personality Prototype (Millon, 1995)

Level Functional Process Structural Process

Behavioral Expressively impulsive, interpersonally irresponsible

—

Phenomenological Cognitively deviant Autonomous self-image, debased objects

Intrapsychic Acting out mechanism Unruly organization Biophysical — Callous mood

rection, it would be Millon’s original breakthrough and his 1969 creation of patterns of mild severity that will be most useful to us.

In terms of empirical support for Millon’s model, factorial studies have shown that the Millon personality prototypes emerge nicely from the items included in the second and third editions of the Millon Clinical Multiaxial Inventory (Choca, 1997; Choca, Retzlaff, Strack, Mouton, & Van Denburg, 1996). No one has been able to show, however, that higher order factors resembling the Millon polarities are part of the structure of any of his tests. Millon (1998) explained that his theory is not a factorial theory and that his personality prototypes do not have the orthogo- nal type of structure that can emerge nicely from factor analytic studies. Future re- search, however, must find a way of validating his concepts if the theory is to be seen as more than some interesting ideas.

REFERENCES

American Psychiatric Association. (1952).Diagnostic and statistical manual of mental disorders(2nd ed.). Washington, DC: Author.

American Psychiatric Association. (1980).Diagnostic and statistical manual of mental disorders(3rd ed.). Washington, DC: Author.

American Psychiatric Association. (1987).Diagnostic and statistical manual of mental disorders(3rd ed., rev.). Washington, DC: Author.

American Psychiatric Association. (1994).Diagnostic and statistical manual of mental disorders(4th ed.). Washington, DC: Author.

Choca, J. P. (1997, August).Millon personality polarities and the MCMI–III.Paper presented at the an- nual convention of the American Psychological Association, Chicago.

Choca, J., Retzlaff, P., Strack, S., Mouton, A., & Van Denburg, E. (1996). Factorial elements of the MCMI–II personality scales.Journal of Personality Disorders, 10,377–383.

Choca, J. P., & Van Denburg, E. (1997).Interpretative guide to the Millon Clinical Multiaxial Inventory (2nd ed.). Washington, DC: American Psychological Association.

Craig, R. J. (1993).Psychological assessment with the Millon Clinical Multiaxial Inventory (II): An in- terpretative guide.Odessa, FL: Psychological Assessment Resources.

Hirschfeld, R. M. A. (1993). Personality disorders: Definition and diagnosis.Journal of Personality Disorders, 7,9–17.

Kernberg, O. (1984).Severe personality disorders.New Haven, CT: Yale University Press. Millon, T. (1969).Modern psychopathology.Philadelphia: Saunders. Millon, T. (1987).Manual for the MCMI–II(2nd ed.). Minneapolis, MN: National Computer Systems. Millon, T. (1990).Toward a new personology: An evolutionary model.New York: Wiley. Millon, T. (1994).MCMI–III manual.Minneapolis, MN: National Computer Systems. Millon, T. (1995).Disorders of personality:DSM–IV and beyond.New York: Wiley. Millon, T. (1998, August). Discussion. In S. Strack (Chair)Millon theory: Data and treatment sugges-

tions.Symposium conducted at the annual convention of the American Psychological Association, San Francisco.

Millon, T., & Millon, R. (1974).Abnormal behavior and personality.Philadelphia: Saunders. Widiger, T. A., & Sanderson, C. (1987). The convergent and discriminant validity of the MCMI as a

measure of theDSM–III personality disorders.Journal of Personality Assessment, 51,228–242.

PERSONALITY PROTOTYPES 363

Widiger, T. A., Williams, J. B. W., Spitzer, R. L., & Frances, A. (1985). The MCMI as a measure of DSM–III. Journal of Personality Assessment, 49,366–378.

James P. Choca School of Psychology Roosevelt University 430 South Michigan Avenue Chicago, IL 60605–1394

Received January 18, 1999

364 CHOCA