– [Seth] Good morning, and welcome to everybody We are going to be taking one of our deeper dives as part of our series on the Millon Clinical Inventories and the classification system that is the backbone of the MCMI-IV This one, having to do with some of the attention-seeking folks that we may be dealing with in our clinical practice, and looking at some delineations between one which is part of the official nomenclature, the histrionic personality, as well as one that is part of the overarching theory that supports the test, and that is a more recent addition, which I’ll talk about in detail in a little while, the turbulent personality Before we begin, we’re still in a little bit of housekeeping mode before we get into the content Because we are offering CDs, and as a standard of practice, I am required to disclose that I am one of the co-authors of the MCMI-IV, and as part of that, I do have a minor financial interest in the instrument So, please bear that in mind as I describe some of the concepts that we’re talking about, although we’re not really getting into the instrument itself, we are talking about concepts that are very closely related There are no non-financial relationships to disclose And I also want to just point out the Pearson Clinical Assessment Division, the sponsor of this webinar, develops and distributes assessments and intervention tools for psychologists and speech-language pathologists, and this webinar covers information that pertains to the effective and appropriate use of one of the Pearson instruments, the MCMI-IV Okay, with that in mind, let’s take a look at what we’re going to be doing today What you have in front of you right now is a, sort of a quick overview from a high level of what we’re going to be looking at, what we’re going to be focusing on throughout the course of this webinar today Part one at the top is going to be very brief We’ve learned over time with the webinars that we’ve presented that are similar to this one that we tend to spend quite a bit of time on the theory itself and that tends to take away from some of the clinical information that follows So we have made an effort in this webinar to really kind of boil that down to some of the essentials I would point to some of our other recorded webinars as well as Dr. Millon’s most recent theory book as well as The Essentials of MCMI-IV Assessment if you want a better overview of the theory itself But I will be covering just the basics as they pertain to our information today Part two is where we’ll be spending most of our time, and in part two, we have our focus on these two patterns from Millon’s theory and how that relates then to scales on the MCMI-IV And throughout this time, we should be looking at these particular objectives, describing the motivating aims which is part of the theory of the histrionic and turbulent personality patterns We want to compare the attention-seeking patterns That’s just one component, but one of particular interest for, for a lot of clinicians, that this is usually a behavior that they want to focus on with people who match some of these patterns: the attention-seeking patterns that are evidenced by both of the prototypes that we’ll be talking about, and from there, we’ll want to explain some treatment directions based on the motivating aims of the individual I’d like to add to this that one of the views that I like to be able to espouse and really try to articulate as best as possible is that, very consistent with a lot of the conversation that’s happening now and has happened for some time, when it comes to personality diagnosis and personality categories, versus dimensions, that this very much is a dimensional approach, despite the use of categorical nomenclature And that should become evident, because as we go along, I’ll be talking about not just the basic patterns that we’re talking about here, but how they admix together First, with some example from when you might see both histrionic and turbulent patterns in one individual and how the basic domains and the dimensions tend to play out there, but then also when you see different admixtures of this pattern with some other patterns And I’ll be going through a couple of examples, one of which is, I would say it’s not based on, but it is inspired by a recent client And I’ll point that out as we go along with that Here’s our basic timeframe, and so far, we’re somewhat on time, we have a few minutes left

of the first component, up until 12:15 p.m We’ll be talking about the motivating aims of both patterns, from there until about halfway through, we’ll be looking at how the two patterns are alike and how the two patterns are different, with a particular focus on attention-seeking, but not necessarily limited to just that And through the last, let’s say, the third quarter of what we’re going to be looking at, approximately, we’re gonna be taking a look at those motivating aims, those domains, and how they relate to a potential treatment course, and try to start to illustrate some of the treatment directions there, and we will try to leave approximately 10 minutes at the end for questions and answers So that’s kind of our schedule for the overall part today, and with that in mind, let’s take a look at our first section, and that would be a very brief recap of Millon’s Evolutionary Theory We’re going to capture this primarily in three slides, very quickly What I’d like you, to try to help you orient to what we do here is first, the top part of this slide That is the evolutionary polarities Think of these as the motivating components of any personality, and they do map out the different categorical personality prototypes that we see on the instrument, but I’d like you to think of them as something a bit more fluid than that, and that is that, without getting into a lot of what I often talk about in terms of the commonalities between this and evolution, just kind of speaking about these as motivations Every human being, matching with the natural world, according to Millon’s theory, has connections to three polarities that represent motivation, the first being pleasure versus pain, which, in essence, is the idea of trying to sustain life on the pain side or to the pain avoidant side, trying to not allow for things that might be destructive to the individual, in this case, from a psychological perspective, versus pleasure, or what is more fulfilling to an individual I wanna point out, before we go to the next one, that you should also think of these as continua and not necessarily one category versus the other The second, active versus passive, which is how we tend to orient ourselves to our world and how we act upon the world, whether that be by an active orientation, which would be entering an environment and making changes to that environment, acting upon the environment, in other words, to make it suit our needs, versus a more passive approach A passive approach being one where we find a suitable enough environment and if there are changes to be made, we make those changes to the self rather than to the environment And then the third, based on the idea that none of us will be here forever, we borrow from evolution the idea of self versus other, which is a concept that I think that we’re very familiar with in psychology, of where do we nurture Do we tend to only try to nurture ourselves, or do we only try to nurture other people, or where do we fall on this continuum? Like I said, with this being a continuum, one of the qualities of a person who is adaptive would be that they have their set or favored ways of being along these different continua, but the environment and the other people in the world and the demands of their life will pull for them to be flexible and adaptive along these continua The more flexible and adaptive while not losing self definition, some may be, the better they probably will be able to adhere to a society, a community, a culture and be able to get along within that context But the more inflexible, the more that they become stuck or conflicted along any one of these points, the more difficulty they may have All of that being said, and this will all become relevant as I describe some of these patterns that we’ll get into in a moment, then play out into what we can observe and what we can infer through eight different domains, or eight different dimensions, if you will, of personality, that are related to four levels, which you’ll see along the first column We have behavioral, phenomenologic, intrapsychic, and biophysical All of these being sort of the major categories in the schools of thought that we have in the world of psychology, different ways that we look at things,

broken down into functional domains, which are those that are more so the ones that we can look at and directly measure, and be able to observe in some sort of a more tangible way, as well as structural domains, which are those that we may need to infer, we may need to gather via different kinds of questioning, and those that are structural, primarily are in the more intrapsychic, more biophysical realm, functional being more behavioral, and to some degree more phenomenological, although there’s some crossover, as you can see As we go along, and as they’re relevant, I’ll be defining each of these eight that fall under the other two columns there as they relate to the patterns that we have The next element that I’d like to take a quick look at is that we have the focus here, as we see in the orange boxes, of which personality patterns we’re looking at as they relate to and as they’re ordered along Millon’s taxonomy, the personality spectra Something to keep in mind here is that the model that sits underneath has become more dimensional, and you can see this, in some ways, by looking across the rows for each one If you look at the first column, you’ll see what we now have as some abbreviations for the common patterns that we know, and then three different levels of functioning Normal style, which for the first one we commonly refer to as schizoid, which is actually the clinical disorder nomenclature, we have an apathetic style, an asocial abnormal type, and a schizoid clinical disorder These three ranges do correlate to base rate scores on the MCMI-IV, the areas of 60 to 74 for the first, 75 to 84 the second, and 85 and above for the third That won’t be a focus of our attention today, but I just want to mention that for basic reference points So the two that we have are approximately the middle of the taxonomy, those are the histrionic and the turbulent, which have associated normal styles and abnormal types We’ll be focusing more on clinical areas in this presentation, but I do want you to keep in mind that there are different variants at different levels of functioning within this model Last point about the theory in general will be that we will be looking at the domains that I referenced earlier If you look across the top, the column headers of this table, show the different domains that I mentioned before in the first slide Expressive emotion, interpersonal conduct, cognitive style, and so on, and down the side, we have the listing of the different spectra, the 15 personality spectra The highlights that you see here are the facet scales, those belong to the Grossman Facet Scales of the MCMI-IV But that is not the limit of what we do in terms of being able to dimensionalize these different aspects, and again, you see where two that we’ll be focusing on are here, about in the middle, along with those that are highlighted for, as a facet scale and those that are just part of this dimensional view of these different characteristics So that is a very brief overview, and I know that it’s a lot of information to fit into sort of a theoretical context in a very short amount of time Please do rest assured that as we go through this, I’m going to be illuminating the relevant points of that as they become part of our focus Let’s take a look at our patterns that we have here We’re going to first distinguish the histrionic and turbulent personality patterns based on both their motivating aims I just referenced, as well as the domains, and how prominent any of the domains may be Beginning with a histrionic spectrum pattern, how these tend to work, across our basic motivations, our motivating aims, and the example that we have here, where the histrionic, which is one from the official nomenclature of the DSM, that we would define, in terms of this theory, not just by the criterion list that we have in the DSM, but by the basic motivations that make up what we call a prototypal pattern You probably won’t find a perfect prototype in your clinical practice, you will find somebody who meets this criteria and matches all of the domains, simply as is You’re going to see admixtures But when you use a prototypal approach

so that we have sort of a reference point for which to be able to compare the real life person, the patient or client that you are seeing in your practice, and what defines the histrionic pattern is a tendency primarily towards two of the motivating patterns, first, the active and second the other orientation So what does that mean? It’s primarily defined by the idea that this is a person who is continually monitoring and adjusting and acting upon the environment in order to help define the self through their interactions with other people There’s other components as well, the idea that they are very actively oriented in the prototypal pattern would define them as being somewhat lacking in terms of being able to shut off, to activate the parasympathetic nervous system, to just simply allow what’s in the world to be A little less so as far as the other, because they are really trying to develop a sense of self and they do have a self-reflection, although it’s not something that they keep in very clear awareness throughout most of, most of their interactions But primarily, we have a pattern here that is defined by that activity and the sense that what they do and who they are and most of what they’re about depends on how it is that others reflect on them When we change to a more molecular view of this, and begin to look at aspects in the domains that might meet some of the criteria of the DSM, as well as what might overlap with the alternative model of the DSM, we start to look at the different domains, those different areas that we looked at To read these, and I’ll be showing you this kind of a slide as well throughout the program today, you wanna note that the larger the circle, the more prominent, at least in terms of how the theory predicts a prototype, how prominent that particular quality might be What we see primarily with the histrionic spectrum is attention-seeking interpersonal conduct, a fickle mood or temperament, relating to their biophysical entity, and what we’ve found in sampling the MCMI-IV, tend to see more of a gregarious self-image, although that seems to be in the theoretical prediction something that’s a bit smaller Rounding out the picture tends to be qualities that mean that it’s very difficult for a person to be able to maintain focus on one and only one thing, where we see something of a flighty cognitive style We tend to see a bit of dissociation when it comes to the way that they relate on a deeper level with people Once a relationship has been used for the purpose that it really needs to be used, it becomes less exciting and becomes less of a focus and there may even be times where it becomes, after awhile, something that, something that becomes less of a, some less of a focus that it almost becomes a dissociated kind of a relationship We will see typically dramatic emotion, we’ll see gregarious self-image, and this is sort of what makes up the overall constellation Once again, though, I wanna point out that this is the prototype for the histrionic, and generally speaking, you won’t see an exact match to this You’re going to see other admixtures, you’re going to see emphases in different places, and more than likely, those of you who are familiar with the MCMI and use that or the MMPI, or really any of the instruments regularly, you will see admixtures with other personality prototypes and patterns The next that will look at is one that is probably not as familiar to most, and that is the turbulent pattern In some ways, looks very much the same, at least on a superficial level, to the histrionic, but there’s very different motivations They share an active orientation They share this active orientation with the world Okay My highlight was not working there Rather than focusing so much on the interpersonal aspects, they do have a very strong push towards interpersonal, but not at their core motivation The emphasis is one, and it’s the only one

throughout the entire spectra of personalities where the emphasis is on pleasure or fulfillment or goal orientation What you tend to see here is a pattern that is oftentimes rather healthy, and remains healthy and remains very spirited and remains very much attuned to the world and it’s goal oriented and goal directed until there becomes a problem, which is that it’s to a level that most people are not, and there tends to be some kind of a dissociation that happens, and there’s a rather sharp turn towards a more clinical presentation at the higher end of the turbulent spectrum And that is that, at some point, they tend to wear people out They’ve brought people along to do their bidding, they’ve brought people along to be involved in what it is that they’re interested in, they develop a lot of attention, as it were, to their world by virtue of being able to keep interest in some kind of a goal, keep interest in some kind of a phenomena in the world And eventually, people say, enough of that, and they’re left in something of an echo chamber This is sort of a typical presentation This happens, not just with one person, and not just at one time, but at different times, we tend to see that a person becomes less attuned and less able to be able to monitor their own affect, and less able to manage, what they see is they’re being goal directed and they’re being in a legitimate and validated sort of view of themselves in the world We then start to see this play out as we look over at the different domains and dimensions Have something of a scattered cognitive style, they really do try to capture all things for all people, that also includes the mercurial mood or temperament to be able to match that mood to whatever might be coming along They tend to be very high spirited, impetuous, and one of the pieces that I’ll be talking about that really relates to the problem of attention-seeking is magnification, which is not one of the facet scales, but it’s one that I think really becomes very important when we look at their interpersonal consciousness Most people, when they get the social cues, that people have reached a limit with whatever it is that they might be talking about, that they are being given appropriate negative sorts of stimuli to say, okay, enough of what you’re talking about, enough of the subject, we need to be able to move on, you’re tiring me out, any of these kind of phenomena, most people will begin to back down Now, we’re talking about people that are able to read social cues And I wouldn’t say that the people with a turbulent pattern cannot read social cues, but they have a different reaction, that is, a magnification That is that what they tend to do is they tend to double down If they’re not getting their attention, they push harder, and if they don’t get their attention from pushing harder, they may push harder still, and so on and so forth, it starts to really, really push on the limits of other people, or the situations that they might be in They find themselves in situations where they’re no longer supported, and at times, possibly, dissociated and misattuned to the rest of their environment This is where the vulnerability to some of the more syndromal kinds of difficulties might come from, such as depression, such as anxiety, and so on and so forth So if you were to look at these two patterns, I wanna kinda highlight the domains that we have here and some of the differences that we see, particularly in the areas that we wanna look at here We have, on the histrionic side, dramatic expression, very much about look at me, look at how much I can be entertaining, how much I can be engaging and gregarious, versus an impetuous expression, and that one being more along the lines of, I’m going to continue to do it It’s not necessarily the emphasis on me, but it does bring about a strong attention-seeking kind of a quality, it’s a matter of where that attention really is Then, okay, the next one down is about the interpersonal realm, attention-seeking, versus high spirited And one you can see is inferring an emotion

that’s much more about being energetic and being very much engaged The other one is about, look again, look at me Won’t go through all of these, but I wanna point out a couple of the areas that are relevant to what we’re talking about, the histrionic being more gregarious, that is, let’s include everybody, let’s bring everybody in The turbulent being more exalted, and that is, I have something that I want to show you and it’s something very special and something that is rather unique to me This also crosses over, to some degree, into narcissistic characteristics Now, we haven’t used narcissistic as one of the co-occurrences in this presentation, but I do wanna just mention that, that there is sometimes an important distinction, a differential diagnosis, or to look at what elements might be from narcissistic patterns versus the turbulent pattern So we have some similarities here and some differences, and let’s take a closer look at how it is that they look together First of all, let’s take a look at the common ground For the histrionic and turbulent attention-seeking sorts of characteristics, just considering for right now the prototypal kind of a presentation What do they have in common? I’d like to divide these out in this presentation into tactics as well as characteristics, so what they do as well as what we might be able to describe Under tactics for both of them, I would say that they both, to some degree, are environmentally based, that is, that they’re not so much based on bringing attention to who they are Now, that changes when you talk about a histrionic personality, because they are bringing attention to themselves, but it’s not about who they are It’s about what they can do in the more communal space With a turbulent, it’s not so much about bringing attention to themselves as bringing the attention to the focus of whatever it is that they might be showing you, doing for themselves, seeking out is the goal They do both tend to use fairly dramatic terms, fairly dramatic language, and both rely to a pretty good degree, except in different places, on exaggeration How that plays out tends to show a difference between the attention-seeking qualities between the two Common characteristics, a primary motivation, I know this is a motivation for pretty much everybody on the planet, but this is a very important one, and I would say it’s a doubled down sort of a motivation for both of these, is validation Seeking to be able to justify the self in any given moment, and I think that part’s very important They both seek out their reinforcement in that way, not necessarily through a deeper relationship with one individual or through one particular pursuit, but by numbers, by being able to say that this is some, yeah, of what they’re pursuing, or what they’re drawing your attention to is something that everybody can appreciate This we infer from the theory, it’s fueled by a deficit that they tend to have in terms of identity, in terms of their inner structure, in terms of feeling like a whole person for who they are on their own, rather than what they do or what they’re pursuing or what they are showing you or what is engaged in activity at any given particular time And finally, I think one of the, one of the key characteristics here is that this is something that we actually try to encourage in some people, and as a general rule, a goal, we like to be able to tell people to be aware of the here and now With this particular, with these particular patterns, we may find that the here and now is over-emphasized, and there may need to be some focus within what we do towards being aware of a larger picture, or being aware of some kind of a consequence or something that may happen in the future Much more so than we would with other people where they’re too worried about the future, they’re too worried about what’s coming down the road, and we need to bring them back into the here and now This would be the different emphasis here Let’s just focus down now on histrionic,

attention-seeking sorts of characteristics, so this is just at this point limited to, although there might be some overlap with, but for the most part, this is what’s more unique to the histrionic, and that is that there’s a tendency on attention-seeking patterns with charisma, gregariousness, a kind of theatric sort of a presentation You might see a very dramatic presentation from a turbulent personality, but it’s, again, usually focused on something outside rather than the focus on me And then the kind of a seductiveness, not necessarily in a sexual or intimate sort of a way, but a seductiveness in terms of bringing you into their world, and it’s more based on personality and more based on interpersonal than it is on any point of interest that they might be talking about, so that these characteristics include that unique motivator, what I call unique primary motivation, interpersonal excitation That is getting a person as excited about just being with this person more so than anything else I would say that histrionic patterns to play the game of life, and I’ll make a comparison to turbulents in a moment that way Their deficit, and that is the fuel for their attention-seeking, tends to be one of intimacy, and that seems a little bit, a little bit unexpected in certain ways, and that is because you might find that they are constantly seeking intimacy, but if you really think about the true definition of intimacy being one where you’re very much able to be vulnerable with another person, and they feel as though the person accepts you just for being you, that really is a deficit in this area And the final one, I think, is really something that becomes very important in terms of interpersonal treatment And that is that, with histrionics, and this differs in the next slide, with the other, there is rarely a circumstance where once a relationship has had its course that they continue to sustain that relationship in that same sort of way There’s of course, exceptions made for family or people that they know are a part of their permanent context, but in terms of how they interact with people, it’s very much about the here and now, particularly with relationships That continues to repeat itself, one after the other after the other, the more the better, at least on a superficial level, but what we tend to see here is that they use the relationships for what they are valued for within that moment, after which time, that tends to dissipate Turning to the turbulent, looking at some of the same areas here, we notice that under common attention-seeking sorts of actions we see passion for a cause A lot of energy, a lot of activity, or a lot of doing, a lot of acting upon the world, not necessarily acting to grab attention for the self, it’s almost more of a byproduct in certain ways, but at the same time, it is also fuel And I think that’s important to remember as well There’s also a seductiveness to this particular pattern, that is, you’re going to be drawn in by people like this, some people that match with this pattern tend to be people who are gurus of some sort, or they are, and I’ve seen many colleagues in the wellness field who tend to espouse some of this Not necessarily by an overactivity, but with such a strong passion and such a strong focus on particular things that you can’t really pull away They will pull you in, based more on interest, based more on what it is that they’re looking at, as opposed to the interpersonal So some common characteristics there, the unique primary motivator here is goal attainment Different again from the histrionic Instead of playing the game of life, they seek to win the game of life, and that is how much can they accomplish, how much can they be able to show, as far as what that, what they’re about, and therefore, that speaks to their deficit, that fuel for that manipulation tends to be entirely under-acknowledged, that is, that their deficit, their feeling that they’re not really whole without their attainment, tends to be very under-acknowledged

And they don’t want to be able to look at that, ’cause that then cycles down to this particular pattern, that is the double down, as I called it As I said before, most people, once they realize that they’ve lost the interest and they’ve lost the attention of somebody, or they’ve read a social cue that shows them a natural boundary, will start to back away from that, whereas this one, because they really tend to be rather desperate to be able to maintain themselves, they’ll double down, they’ll hold on to relationships, even though the relationship seems to be one that has run its course They will continue to try to keep those relationships alive, afloat, despite them not being necessarily the most effective way of interpersonally relating So just to summarize a little bit here, if we look, one to the other, the histrionic, relationally driven for excitement Turbulent, relationally driven to meet goals But the histrionic is more about the game of life as opposed to winning the game of life Histrionic tends to be aware of, and I did mention this before, but sometimes may even operationally flaunt some of their deficits in order to gain attention, where the turbulent tends to be that they don’t want to be aware of, and they tend to suppress or possibly repress their deficits that they find within themselves and keep them completely out of awareness And finally, in terms of sustained relationships, with histrionic, it’s more so what is it about the next relationship, where the turbulent must try to keep this as important as possible, because a losing of that relationship would be a losing at that goal If you look at them together, we can see that there really is some overlap between the two, and at this point, I want to start to look at some examples of what happens when you begin to combine these two patterns, first, with each other, and then we’ll use some examples of when these patterns are comingled with others in Millon’s taxonomy and in the DSM If we were to see someone who presents or maybe co-elevates on an MCMI, both 4A and 4B, I would tend to say that if we’re looking at the motivating aims, we’re probably going to see that there’s quite an extreme going on, more than likely, as far as a person tending to be very active, very much oriented towards changing the environment, to making what’s out there theirs to assert rather than trying to accommodate to what might be out there in the environment That has some very obvious sorts of deficits in terms of how it is that they might be able to relate to circumstances as well as their world For this pattern, you would probably see that there’s probably much more of an emphasis on the other person, and it’s much more about fulfillment So you can start to see both of those characteristics be combined in some ways, such that it may become more like, I would say that there’s some confusion between this and potentially some narcissistic characteristics, because it really does become continued fulfillment, and one of the main differences is that the emphasis really continues to be on the other, whereas, with a narcissistic pattern, it would be more like an emphasis on the self and what do I get for me rather than what do we get together, but the validation comes from what can we do, what do we get, how do you and I really share this thing, share what’s going on in our world right now So, if we were to look at some possibilities of combinations, what I’ve done here is I’ve used a color scheme, and I’ll explain this very briefly here for those domains that are derived from histrionic, those are in red, the ones in blue are from the turbulent pattern, and where we see a co-elevation, we’ll use a purple, which is a combination of the colors The ones that are shaded are also ones that on the MCMI are facet scales If you notice with looking at these, that even if it’s a facet scale, it may not be emphasized, so for example, fickle mood, temperament in this example, although it’s a facet scale, although it’s one that tends to show up here, it’s not very prominent in this presentation So here’s just one example, and I’ll show you another, of when we combine 4A and 4B This one being very much about the attention-seeking

You can see that that’s really kind of the most prominent out of all of the domains That, combined with high-spiritedness, so that the attention-seeking is not going to be one where you see sort of the dramatic malaise, or one where you see a very emotionally driven kind of an attention-seeking It’s going to be about continuous activity with impetuous emotion, that is, impetuous behaviors I’ve drawn some of the histrionic components rather large, this shallow content, meaning that it’s really so much more about what’s happening in the moment than it is about the real connection between the two people, although, within the moment, that connection might be very important, and to some degree, a dissociation, in a way, so that you really do see kind of a prominent turbulent pattern here with some aspects of letting go of any kind of a longer term idea or a deeper connection with another person A different example, here we’re looking at one that tends to be a bit more driven by, in this one, the magnification I was talking about, the constantly pushing for continuing to keep a person’s attention, even beyond what might be useful for the individual So magnification dynamic of the turbulent, combined with the dramatic expression, attention-seeking interpersonal conduct and, something of a scattered cognitive style I notice that I’ve colored one of these wrong The exalted self-image should be one that’s in blue That tends to be relatively prominent as well You’ll start to see how these tend to look somewhat different depending on where the emphasis is, and any one of these different domains may be more or less prominent, depending on the individual that you might be working with We’re gonna move on a little bit now to what happens when we see combinations that we might find with other personalities So these, what I wanna try to point out is looking at when either the histrionic or the turbulent is combined with this one other pattern, and for this, I’ve chosen to use the compulsive pattern To describe the compulsive a little bit, just so we have some background here, because we’ll be using this consistently throughout the rest of the presentation, a compulsive is one where the emphasis is on a passivity and an other-orientation where a person is very rule bound and duty bound and tends to really adhere themselves very closely to what it is that society expects It’s not really about the other as much as it is about the world and the environment around What do I need to do? How do I need to be? Which actions do I need to take within my world to be a good and valid and moral, et cetera, et cetera, type of person The big yellow arrows pointing at each other represent, though, the big conflict that really kinda creates the problem with a compulsive, and that is that they completely deny their own self needs and their own self beliefs that might be any bit contrary to what’s expected of them, therefore, you tend to have this rather powerful kind of a conflict between the sense of self and the sense of other, that creates a lot of unrest and usually happens under the surface So what would happen here? I would say that we may have more of an active conflict between active and passive as well, so you’re going to see conflict not just in terms of getting their own needs met, but whether or not they should take their own actions and act on their own best interests, versus what’s expected of them And I think about how that would conflict with more the superficial qualities of a histrionic personality, where you have someone who really needs to have that kind of validation from others, needs to have a lot of people notice what they’re doing, and at the same time, is trying to deny that need for, kind of the popular way of being So that’s another possibility and another combination When we look at that in terms of the combination of elements, we’ll start to see, in this example, this is just one example of what may come of this, the attention-seeking sorts of behavior,

but also a very strong discipline, almost like those two may coalesce in some ways And difficulty with emotion, I would say, that’s probably derived a lot from those conflicts, from the idea that they’re never really getting their needs met, they both need to be organized and facile with what they do, and attentive and disciplined to what they need as well as well-liked, as well as well-regarded, so you can see where some of those conflicts may come in A different combination, and I alluded to this at the beginning of the program, this one was, to some degree, inspired by results that I got from a client recently on an MCMI Interesting note on this one, that they were compelled to come see me for some professionally related behavior And they were given, as part of an overall psych evaluation outside of my own, a full neuropsych and cognitive psych exam as well as one personality instrument, not an MMPI or an MCMI, one of the other instruments that’s commonly used, and the emphasis was definitely not there, but the pieces that that put together described this person more as narcissistic than what I’d found once I gave them an MCMI, as well as an MMPI-2-RF and a Rorschach, and it was pretty consistent, that these patterns tend to come out If you have a 4B turbulent pattern, that active pleasure orientation, very goal-directed, very goal-oriented, combined with the compulsive characteristics, where we eschew our own personal needs and we do whatever it is that we need to do for the world, what we tend to see, with some, with a pattern like this, and I’ll describe a little bit of this, this is a person who did a lot of professional consulting, and was in different environments at different times and was not always completely familiar with the rules and regulations, the policies and procedures of every organization, and ended up doing some things that were, I would say, on a moral basis, you could make a very good argument for what this person did, but it was clearly against the ethics of the particular establishment that this person was working in So that was what ended up prompting, prompting their referral for an evaluation, and ultimately, for treatment What did we end up having here? We ended up having a person who was very clear about what their objectives were, and very passionate about what they wanted to do and what they wanted to accomplish, and almost would stop at nothing to do that, and adopting what they felt was their own moral or ethic about the general field that they were in, and acting upon that rather than acting upon and missing the point of the differences between different entities, where one might have certain rules and another might have, even moderately different rules, and that ends up becoming the difficulty for this particular individual We tended to see magnification, you see in the bottom right over here, that they continue to double down in their efforts They were fairly insistent that what they were about was really the correct way of doing things They were very disciplined about how it was that they did that, this person did amazing amounts of work in a very short amount of time One of the vulnerabilities, though, was the constriction from the compulsive side So you imagine, a constricted cognitive style, thinking of it in one very clear way, combined with the magnification that you would see in more of the turbulent pattern, you can see where this would get into quite a bit of trouble I’m noticing that, again, and despite our efforts to try to really tighten up the front end in talking about theory, once again, we’ve kind of come against our time to a degree, so I’m not going to go into the detail that we usually go into, as far as the treatment objectives, but I’m going to move on toward the end, and open this up now for questions that we might have So for that, I’m going to turn that over, again, to Dr. Maccow, and field some questions that we might have in the remaining time that we’re looking at today – [Dr. Maccow] Okay, thank you so much, Dr. Grossman, and there are a few questions One is about forensic evaluations

Are elevations on the social desirability scale reflective of both of these patterns, histrionic and turbulent, when you also get elevations on those scales? – [Seth] Yeah, they are, we do have some incidental evidence right now that there is some co-elevation, particularly with the turbulent pattern, and a part of that is because of how that construct is put together, and that is, that, as I mentioned at the beginning of the program today, that this is a pattern that really tends to be relatively pro-social, tends to be, to go after a lot of very socially desirable kinds of conquests and kinds of goals, and that’s very difficult to differentiate The items, as we’ve been looking at this problem, really are worded in a way that people who are not necessarily trying to be socially desirable would probably differentiate between that and what their real patterns are, but if there is a tendency to be socially desirable, you’re going to see something of a Y, (dog yapping) of a Y-scale emphasis as well as a 4B It doesn’t tend to be as much of a co-elevation on the histrionic scale And I also mentioned that on the MCMI-III, this tended to be a difficulty with the compulsive scale It’s no longer a difficulty there either, so it’s something that we’re aware of and when you’re talking about forensic evaluations, you really do need to make some differentiation there and take a look at the context and why it is that they might be responding to some of the items on the turbulent scale the way that they are, that are different from items that are on the Y-scale – [Dr. Maccow] Okay, thank you, and the language of fickle, when you think about temperament as fickle and mercurial, how would you differentiate between the two? – [Seth] The way that I would think about that one would be, fickle, to me, sort of represents the idea that you really kind of move from one to the other to the other without any really true through line So one mood is completely divorced, in a way, from the next one, so that you might see that this particular mood that you’re in because of the interactions you have in the immediate, is just about that moment, and then, something else happens or the attention is brought to another individual or another circumstance, and the mood is downed Whereas for the other, I think there may be more of a through line between moods, but it’s that, mercurial would be more along the lines of giving your mood and affect, it’s all, in terms of, whatever’s happening in that moment, but not necessarily completely unaffected from one to the next Off the top of my head, that’s probably the best I can really differentiate the two ideas – [Dr. Maccow] Okay, thank you And then another question, I went through Millon’s 2011 text, but still have difficulties articulating the difference between the turbulent personality at the clinical level and a manic episode Is the difference similar to melancholic personality versus depression? – [Seth] I think it’s a pretty good parallel I think looking at those two in that way, it’s very much a parallel The depression example has one other stopping point which becomes even more muddy in certain ways, and that is, we now have major depression and persistent depression disorder And the difference between that and a melancholic personality really has much more to do with an overall pattern, including all of those different domains, and being able to draw from that is something that is more lifelong in characteristic rather than something that is occurring in the immediate, whether that’s more sustained, or whether that’s more, just in that particular moment I think it’s clear, with a manic episode versus a turbulent personality, that a manic episode, you oftentimes really take leave of any kind of a good grasp of reality Whereas with a turbulent personality, there’s more extreme, you would probably see more of a connection to reality, but more of a willfully ignoring certain aspects of it, and not to the same extreme as a manic episode – [Dr. Maccow] Okay, thank you And then finally, does borderline personality disorder

overlap more than other personality disorders? – [Seth] It’s fairly well-established, I think, with histrionic that that is the case, that histrionic as well as negativistic or passive-aggressive personality, which is no longer part of the official nomenclature, but histrionic, certainly, is one where it’s been demonstrated that there’s quite a bit of overlap There’s not enough evidence, at this point, to make that same declaration with turbulent, but in terms of the theory, I could see that being a phenomenon that would match – [Dr. Maccow] Okay, thank you very much, and thanks everybody for joining us today