Mental disorders have been categorized in various ways since the beginning of psychiatry, clinical psychology and psychoanalysis. For example, psychiatrists distinguish between neurotic and psychotic disorders. This categorization filters disorders on the basis of their severity.
Recently I have explored another way of categorizing mental disturbances, which divides people into two broad personality types: intropaths and extropaths. By intropaths, I mean disorders in which an individual’s emotional disturbance is primarily internalized—that is, the disturbance is taken out on the self. By extropaths, I mean disorders in which an individual’s emotional disturbance is primarily externalized—that is, it is taken out on others.
Intropaths are people who have internalized disorders that end up doing harm to themselves. A clear example of an internalized disorder would be the self-defeating personality. Self-defeating personalities are those who, due to sexual, physical or emotional abuse during childhood, are drawn to situations in which they unconsciously provoke abuse to themselves as adults.
Extropaths are people who have externalized disorders that do harm to others. A clear example of this is the sadistic personality disorder. Sadistic personalities are those who, due to an overly permissive childhood or a childhood that engenders a bullying behavior, are drawn to situations in which they unconsciously take out anger on others in adulthood.
Externalized disorders might include narcissistic personality disorder, paranoid personality disorder, antisocial personality disorder, sociopathic personality disorder, passive-aggressive personality disorder and cyclothymic personality disorder, to name a few. In all these disorder individuals find reasons to act in a way that is harmful to others. The narcissistic personality uses and punishes people when they are not of use. (Think of the queen in the fairy tale, “Snow White.). Using and punishing people is a way the narcissist handles anxiety about his or her inferiority.
Paranoid personalities handle anxiety by being aggressive toward those perceived as enemies; antisocial personalities harbor a rage against all people, whom they think are deceitful; Sociopathic personalities are crueler than antisocial personalities; passive aggressive personalities handle their fears by being sneaky aggressors; and cyclothymic personalities can express anger to others during their highs while remaining unconscious of their aggression.
Externalized disorders thus provide a way of maintaining a sense of well-being. By dumping their disturbance on others, these individuals find proof of their superiority over others and at the same time manage to relieve themselves of their anger. On the other hand, they build up a lot of unconscious guilt that causes emotional wear and tear.
Internalized disorders might include dependent personality disorder, dysthymic disorder (neurotic depression), avoidant personality disorder, hypochondriac disorder, generalized anxiety disorder and post-traumatic stress disorder, to name a few. Dependent personalities need approval and when they don’t get it they suffer; dysthymic people suffer from depression that is fueled by regrets; avoidant personalities have learned to deal with upsets by avoiding people, which leads to isolation and loss of self-esteem; hypochondriac people transfer their anxiety into physical symptoms; people who suffer from generalized anxiety internalize their anxiety and also develop various physical symptoms; and people with PTSD develop depression associated with a recent traumatic experience.
Internalized disorders thus cause more suffering than externalized disorders. A person with a dependent personality might be attracted to a narcissistic personality and will become the latter’s victim. Because they internalize their disturbance, they are more prone to feelings of dejection and other feelings associated with lower self-esteem, because they are more likely to perceive themselves as victims.
Intropaths are most likely to seek therapy, for the same reason: they more often experience themselves negatively, based on how often the feel victimized. Extropaths are least likely to pursue therapy, because they more often perceive themselves positively; by acting out their disturbance on others, they can maintain the illusion that they are fine and don’t need therapy. Intropaths victimize themselves. Extropaths victimize others.
This division of disorders into internalized and externalized disorders brings to mind another theory by Rotter, which divided individuals into internals (who believe they are in charge of their destiny) and externals (who believe their fate depends on external forces, such as God, the devil, the stars or luck). Rotter believed that internals were healthier, because they feel they have the ability to control their own destiny.
Similarly, intropaths, because they are open to knowing themselves and exploring their psychodynamics in therapy, are more able to change. Extropaths, because they are not open to truly knowing themselves, are less likely to change.