Self-defeating personality disorder

Self-defeating personality disorder
Self-defeating personality disorder
Other names	Masochistic personality disorder
Specialty	Psychiatry
Complications	Dysthymia, major depressive episode
Usual onset	Early adulthood
Risk factors	Family history, abuse
Differential diagnosis	physical, sexual or psychological abuse, major depressive disorder

Self-defeating personality disorder (also known as masochistic personality disorder) was a proposed personality disorder. As a descriptor for "Other personality disorder" it was included in the DSM-III in 1980.^[2]^: 330^[a]. It was discussed in an appendix of the revised DSM-III-R in 1987,^[1]^: 371 but was never formally admitted into the manual. The distinction was not seen as clinically valuable because of its significant overlap with other personality disorders (borderline, avoidant and dependent).^[3] Both the DSM-III and DSM-III-R separated the condition from sexual masochism.^[2]^: 274^[1]^: 287

It was entirely excluded from the DSM-IV. Since the DSM-5, the diagnoses other specified / unspecified personality disorder have mostly replaced its use.^[4]

Diagnosis

Definition proposed in DSM III-R for further review

Self-defeating personality disorder is:

A) A pervasive pattern of self-defeating behavior, beginning by early adulthood and present in a variety of contexts. The person may often avoid or undermine pleasurable experiences, be drawn to situations or relationships in which they will suffer, and prevent others from helping them, as indicated by at least five of the following:

chooses people and situations that lead to disappointment, failure, or mistreatment even when better options are clearly available
rejects or makes ineffective the attempts of others to help them
following positive personal events (e.g., new achievement), responds with depression, guilt, or a behavior that produces pain (e.g., an accident)
incites angry or rejecting responses from others and then feels hurt, defeated, or humiliated (e.g., makes fun of spouse in public, provoking an angry retort, then feels devastated)
rejects opportunities for pleasure, or is reluctant to acknowledge enjoying themselves (despite having adequate social skills and the capacity for pleasure)
fails to accomplish tasks crucial to their personal objectives despite having demonstrated ability to do so (e.g., helps fellow students write papers, but is unable to write their own)
is uninterested in or rejects people who consistently treat them well
engages in excessive self-sacrifice that is unsolicited by the intended recipients of the sacrifice
The person may often avoid or undermine pleasurable experiences [...] [and] rejects opportunities for pleasure, or is reluctant to acknowledge enjoying themselves

B) The behaviors in A do not occur exclusively in response to, or in anticipation of, being physically, sexually, or psychologically abused.

C) The behaviors in A do not occur only when the person is depressed.^[1]^: 373

Exclusion from DSM-IV

Historically, masochism has been associated with submissiveness. This disorder became politically controversial when associated with domestic violence, which was considered to be mostly caused by males.^[5] However, a number of studies suggest that the disorder is common.^[6]^[7] In spite of its exclusion from DSM-IV in 1994, it continues to enjoy widespread currency amongst clinicians as a construct that explains many facets of human behaviour.^[5]

Millon's subtypes

Theodore Millon has proposed four subtypes of masochist. Any individual masochist may fit into none, one or more of the following subtypes:^[5]^[8]

Subtype	Description	Personality traits
Virtuous masochist	Including histrionic features	Proudly unselfish, self-denying, and self-sacrificial; self-ascetic; weighty burdens are judged noble, righteous, and saintly; others must recognize loyalty and faithfulness; gratitude and appreciation expected for altruism and forbearance.
Possessive masochist	Including negativistic features	Bewitches and ensnares by becoming jealous, overprotective, and indispensable; entraps, takes control, conquers, enslaves, and dominates others by being sacrificial to a fault; control by obligatory dependence.
Self-undoing masochist	Including avoidant features	Is "wrecked by success"; experiences "victory through defeat"; gratified by personal misfortunes, failures, humiliations, and ordeals; eschews best interests; chooses to be victimized, ruined, disgraced.
Oppressed masochist	Including depressive features	Experiences genuine misery, despair, hardship, anguish, torment, illness; grievances used to create guilt in others; resentments vented by exempting from responsibilities and burdening "oppressors".

Notes

^ "Other Personality Disorder should be used when the clinician judges that a specific Personality Disorder not included in this classification is appropriate, such as Masochistic, Impulsive, or Immature Personality Disorder. In such instances the clinician should record the specific Other Personality Disorder, using the 301.89 code."

References

^ ^a ^b ^c ^d ^e ^f ^g Diagnostic and Statistical Manual of Mental Disorders (3rd Revised ed.). 1987.
^ ^a ^b Diagnostic and statistical manual of mental disorders (3rd ed.). 1980.
^ Reich, J. (1987). "Prevalence of DSM-III-R self-defeating (masochistic) personality disorder in normal and outpatient populations". The Journal of Nervous and Mental Disease. 175 (1): 52–54. doi:10.1097/00005053-198701000-00009. PMID 3806073. Archived from the original on 2022-10-14. Retrieved 2022-10-12.
^ Diagnostic and statistical manual of mental disorders : DSM-5. American Psychiatric Association, American Psychiatric Association. DSM-5 Task Force (5th ed.). Arlington, VA: American Psychiatric Association. 2013. ISBN 978-0-89042-554-1. OCLC 830807378. Archived from the original on 2020-08-07. Retrieved 2022-04-24.{{cite book}}: CS1 maint: others (link)
^ ^a ^b ^c Theodore Millon; et al. (8 November 2004). Personality Disorders in Modern Life (2nd ed.). Hoboken, N.J.: Wiley. p. 86. ISBN 978-0-471-66850-3.
^ Kass, Frederic (June 1987). "Self-Defeating Personality Disorder: An Empirical Study". Journal of Personality Disorders. 1 (2): 168–173. doi:10.1521/pedi.1987.1.2.168.
^ Reich, J (January 1987). "Prevalence of DSM-III-R self-defeating (masochistic) personality disorder in normal and outpatient populations". J Nerv Ment Dis. 175 (1): 52–4. doi:10.1097/00005053-198701000-00009. PMID 3806073.
^ "Millon, Theodore – Personality Subtypes". Archived from the original on 2013-10-23. Retrieved 2009-12-24.