Aggressivity in the context of pathological personalities

Aggressivity is a social behavior resulting from the need for defense or the will to obtain advantages in the area of interpersonal competitiveness or as an expression of individual vulnerability corresponding to self-aggressive behaviors.

The motivations for this behavior can be biological, psychosocial or cultural. We distinguish between reactive human aggressivity – which is a response to negative stimuli or challenges, usually being conjunctural – and proactive aggressivity, usually motivated by a personal goal and having a more elaborate character. The substrate of aggressivity is ascribed to the social brain and mainly involves the morphofunctionality of the frontal lobe^(1,10).

In the field of pathological personalities, we encounter the highest diversity of aggressive behaviors, of various etiology, as well as regarding the ways of manifestation and intensity. The complexity of aggressive acts implications, from the moral to the medico-legal ones, is also situated in the same context. The dynamics of the clinical and evolutionary characteristics of aggressivity vary according to each type of personality disorder. Extreme variants of hetero-aggressive and self-harm behaviors are described in antisocial personality disorder (APD) and borderline personality disorder (BPD). Aggressivity becomes one of the major reasons for the presentation of subjects with personality disorders to a psychiatric service, either by free will or compelled by the authorities or family^(3,5).

In the field of personality disorders, we also find the two extremes of the aggressor-victim binomial, represented by APD and dependent personality disorder (DPD).

In paranoid personality disorder (PPD), we encounter a remarkable potential for aggressive behavior, especially in the case of the sthenic or actively domineering variants characterized by an increased level of conflictuality.

The structural attributes engaged in this context are represented by pathological pride, which explains envy, jealousy, intolerance of frustrations and failures. The objective reality is distorted by the paranoid belief that the person is being deceived, manipulated or exploited, and along with the deficiency of affective modulation, anxious feelings and the sense of danger are also maintained. As a consequence, any emotional message or intimacy has the value of a threatening intent. This variant of vulnerability, together with the conjunctural factors, underpins the aggressive behavior. Thus, diverse variants of failure or the feeling of losing control over the entourage are involved. The latter is extremely reduced because the paranoid persons select the people around them carefully and with utmost caution. The relationship with them, including the life partner, is dominated by the fear of closeness and intimacy, rigidity, mistrust, intransigence and hostility, with conflictual states from which the paranoid individual always emerges victorious. Regarding the relation with the life partner, the paranoid person is always suspicious and hostile, the problem of fidelity being a persistent one. In this framework, we encounter various types of anxiety, from anticipatory to diffuse. Thus, the relationship with the partner frequently leads to aggressive behavioral manifestations, including forensic ones^(5,6,8).

Schizoid personality disorder is characterized by particular structural attributes, aggressive behavior being rarely noticed, nonspecific and always unpredictable. This has nothing to do with the emotional experiences of the subject, his motivations being always bizarre and acontextual. This is due to an aberrant ego-syntony in which cognitive and affective detachment maintain the solitary lifestyle while ignoring social norms. The schizoid can create strange scenarios, detached from reality that could justify aggressive behavior. He can also be drawn or manipulated into situations whose dangerousness he cannot appreciate^(2,3).

The pathologic structural attributes specific to schizotypal personality disorder (TPS) belong to the prodromal states of schizophrenic psychoses. Corresponding to recurrent states of derealization, described both in PPD and schizoid personality disorder, the schizotypal is dominated by strange beliefs and convictions of a parapsychological nature that sustain its sense of self-assumed and strange superiority. The contexts in which the schizotypal cannot show off his “particular qualities”, or these are not acknowledged, can favor aggressive behavior that is otherwise rarely encountered and mainly attributable to psychotic decompensations^(2,6).

The structural attributes of the narcissistic personality are the feeling of superiority and grandeur – i.e., the feeling that “he deserves it”, the need to be noticed, the need for admiration and unconditional favorable treatment. In the same framework, egoistic emotions and feelings related to one’s own subjectivity as personal interests, envy and hypersensitivity to criticism are also associated. His morality is conjunctural and inauthentic and can associate antisocial traits such as lack of impulse control and irresponsibility. The aforementioned structural attributes can favor aggressive behavior when there is no “valuing” confirmation from the entourage, the subject feels inferior, weak or is ridiculed, disregarded or devalued. The narcissist’s very fragile and easily damaged reputation remains the main contributing factor to his aggressivity. Aggressive behavior viewed as a reaction to frustration or humiliation frequently remains at the level of narcissistic discourse. It can be ascribed to reactive depressive states sometimes accompanied by attempts at self-suppression with increased mortality, as the ultimate expression of wounded grandeur. Other times, in the sense of hetero-aggressivity, dysphoric episodes with attitudes of retaliation, humiliation and mockery of the entourage can appear. Forensic implications are not a rule but must sometimes be taken into account^(2,12).

Aggressivity in histrionic personality disorder derives from the fragility of the ego corresponding to the low self-esteem and from the greatly diminished capacity for self-control and simultaneous dependency on the attitude of those around. Structural dominants such as immaturity, affective lability and egocentric, theatrical and manipulative behavior do not directly promote hostility and aggression. But the hyper-expressiveness of the behavior can have an aggressive note corresponding to the incisiveness and lack of reticence. In this way, scam, intrigue and blackmailing behaviors become characteristic, aiming mainly at the manipulation of the entourage in order to obtain a secondary benefit. Alternatively and for compensating, the histrionic person may have a mannered, affectionate or pedantic demeanor. Severe aggressive acts or acts with legal implications are rarely committed, their presence being aprioristically accidental^(3,10).

Aggressiveness in borderline personality disorder is underestimated, the psycho-affective and attitudinal instability being always connected to the dynamics of contemporary society. The relativism of the frequency is due to the specificity of the borderline structure which represents a coalition of maladaptive traits and psychopathological symptoms, the high incidence of depressive or psychotic episodes and toxicophilic behavior being almost a rule. Engaging structural attributes are represented by a chronic sense of inner emptiness that sustains ongoing subjective discomfort as well as the instability of self-image, mood and relational capacities. In their absolute need for dependence and attachment, borderline personalities find the world around them simultaneously indispensable and unbearable. This fact is the source of impulsive behaviors, hyperreactivity and attitudinal disinhibition⁽⁷⁾. In this context, the lack of self-control favors acts of self-harm, but frequently, also, autolytic attempts of varying severity, the repetition of them being a marker of unfavorable prognosis. In interpersonal relationships, autobiographical hypermnesia with negative content favor the reactualization of experiences similar to those experienced previously, as well as the feeling of real or imaginary abandonment. Borderline personalities oscillate between attitudes of self-devaluation and submissive submission, real or imaginary ephemeral attachment relationships, but also hostile, offensive and hateful attitudes. The aggressivity of these subjects is ascribed to tendencies of short-circuital reactions, associated with the ignorance of their secondary consequences. The anxiety and ambivalence that accompany the need for interpersonal attachment can result in dysphoric episodes that are extremely difficult to control^(3,8,12).

Obsessive-compulsive personality is defined by two dominant structural attributes, namely anxiety and rigor with hypertrophied pride and self-esteem. The obsessive person imposes and demands impeccable conduct and, also, flawless role involvement. By ascribing to himself special moral qualities, the obsessive individual has a sense of personal truth that makes him intolerant and inflexible. Thus, he does not accept changes, points of view different from his own, he does not adapt to circumstances and does not like surprises. He always acts in a deliberate and controlled manner, trying to avoid any frustration or loss of self-control or control over others. This behavioral style underpins an increased vulnerability in life roles and interpersonal relationships, with anxious feelings, ambivalence and the exclusion of failure always being in the foreground. In this framework, the collapse of self-esteem can mean a particular autolytic risk corresponding to micromanic slippage that is very difficult to control by the obsessive individual in case of failure or lack of compliant feedback from the entourage. Hetero-aggressivity is addressed to the entourage and usually remains at the level of speech, without moving into action. In the family and in the professional environment, he is a promoter of order and respect for hierarchies, always trying to approach the people in the most advantageous positions to use this as a narcissistic valorizing argument^(3,9).

The dependent personality is characterized by a marked self-insufficiency due to a hypotrophied ego that has progressively introjected the superiority of those around him. Self-devaluation tendencies, submissive and sometimes humiliating behavior and the need for attachment are dominant. The dependent subject experiences his solitude anxiously and attaches himself unconditionally to a person whom he considers trustworthy. Thus, the dependent personality is a personological structure ascribed to social phobias, always oscillating between self-blame and the often-phantasmagorical blame of the subject to which he feels attached. The loss or anticipation of the loss of the dependent relationship can favor self-aggressive behavior, with autolytic attempts with low or high mortality, the latter in loss of hope conditions. In male subjects, hyper-aggressive manifestations may occur, culminating in the killing of the partner followed by suicide^(3,5).

The avoidant personality is a prototype of self-esteem deficiency, experiencing extremely anxiously his own solitude and, also, any relation to the people around him. The avoidant is an author of distressing scenarios in which he might be involved in an interpersonal relationship and masks his need for attachment with fluctuating skill. Any attribute from the spectrum of aggressivity is addressed only to the subject who, in certain circumstances, may take into consideration autolytic attempts, including accidental ones.

The most intense and immoral variant of aggressive behavior belongs to antisocial personalities. Pathological pride, audacity and attitudinal disinhibition maintain a quasi-continuous latent aggression directed in the overwhelming majority of situations at those around them. They are treated with cynicism, sadism and contempt, being considered, according to purely subjective criteria, subordinate beings, lacking qualities and “worthy” to be controlled and humiliated. Hypotrophy of the superego underpins the subjects’ acts of aggression and bodily harm, along with recurrent clastic manifestations. Overt hetero-aggressivity can culminate in immoral actions, including criminal acts^(2,4,8).

The aggressivity of antisocial personalities can be used in extreme conditions where other people would be overwhelmed by the sense of danger. Accidental or induced autolytic attempts with increased mortality are rarely possible, due to a paroxysmal micromanic sideslip corresponding to a major existential failure.

The conditions of comorbidity with the Axis I diseases of the various personopathies are well known and, in this context, it is necessary to differentiate the transient aggressive manifestations from the constitutionally conditioned ones.

Aggressive manifestations seen as a whole can always be favored or triggered by the abuse of alcohol and/or psychoactive substances.

The diversity of the forms and the variability of the manifestations of aggressivity can be understood to the greatest extent in the field of pathological personalities, with the exception of organic lesional conditions of the brain. In this way, a series of behavioral prototypes of aggressivity that can be attributed to the human condition emerge⁽¹¹⁾.

Hetero-aggressivity is increased in borderline and paranoid personalities, being the specific attribute of antisocial personalities. It usually remains at the level of verbal hetero-aggressivity in narcissistic and obsessive-compulsive personalities. Self-aggressive manifestations are mainly the prerogative of borderline personalities, but also of narcissistic, dependent and obsessive-compulsive ones. In their simulated variants, they are depicted in histrionic personalities. Aggressive potential can be masked in paranoid, narcissistic and obsessive personalities, and the auto-aggressive one can be concealed in obsessive and dependent personality disorders^(3,6).

Overall, the particularities of functioning in life roles, economic status and sociocultural level can shade, mask or potentiate the described variants of personological vulnerability. 

 

Conflict of interest: none declared

Financial support: none declared

This work is permanently accessible online free of charge and published under the CC-BY.