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
| Self-defeating personality disorder | |
|---|---|
| Other names | Masochistic personality disorder |
| Specialty | Psychiatry |
| Complications | Dysthymia, major depressive episode[1] |
| Usual onset | Early adulthood[1] |
| Risk factors | Family history, abuse[1] |
| Differential diagnosis | physical, sexual or psychological abuse, major depressive disorder[1] |
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". |