Five Levels of Personality Functioning

This blog was co-authored with Marcia Gralha, M.A.

Human personality concerns (a) how we are all alike (i.e., human nature), (b) how we are like some other people (i.e., individual differences), and (c) how we emerge as unique individuals (i.e., our personal psyches).

Personality functioning is divided into five different levels, ranging from optimally adaptive to completely dysfunctional.

The standard to think about personality functioning is via the "medical model," which is made official by the Diagnostic and Statistical Manual of Mental Disorders 5-TR. This is the "bible" of mental disorders, and generally subscribed to by all the health professions because it regulates things like insurance. Because it adopts a medical model, the DSM (and thus health professionals) frames personality functioning via the “categorical” approach. This means it starts with the question: "Does the person have a personality disorder?" which is defined by a set of criteria relating to long-standing problems with identity and relationships. If the answer is "no," then the patient is considered "normal." If yes, then, presumably, they fit into one of the ten different kinds listed, such as antisocial, dependent, and borderline (see here for the descriptions). If none of these fit, then a clinician may diagnose the patient with personality disorder-not otherwise specified.

If you think about people you know, you likely see that there is really a massive range of functioning rather than a simple dichotomy. This is consistent with much empirical research. Many have challenged the dichotomy/category model. As the DSM-V was being constructed, there was a huge push to shift it from a categorical approach to a dimensional approach. The goal was to develop a levels of functioning approach. In fact, this alternative almost replaced the categorical approach in the DSM-V. However, conflicts emerged in the months leading up to the publication, and the change did not happen. The dimensional system was placed as an appendix in the DSM. Unsurprisingly, many people were not happy.

This blog builds from the work done on the dimensional approach (see, e.g., here), but it adds the lens of UTOK, the Unified Theory of Knowledge¹. Doing so allows us to identify three major domains of personality functioning consistent with UTOK's model of human consciousness. The first area is identity, or ego functioning. This refers to the person’s self-concept, the level of identity integration, and effective self-directedness. The second domain is emotional functioning, referring to the range of emotions a person can experience, the alignment of emotional reactivity to the situation, and the degree to which emotions can be adaptively integrated, regulated, and expressed. The third domain is relationships, and refers to the quality and quantity of connections a person has, with a particular focus on the degree of intimacy, trust, empathy, and mutuality.

In addition to the domains of identity, emotions, and relationships, we also need to consider the context of the individual. In what follows, we describe five different levels of personality functioning, framed by identity, emotions, and relationships. We also do so via two words, with the first describing how the individual is under normal circumstances, and the second when they are under duress. (Personality functioning relates to well-being, and for a quick assessment of well-being that overlaps with the description, see here).

Five Levels of Personality Functioning

1. Healthy-Resilient

A healthy-resilient individual feels “at home” with themselves, has a complex, rich, differentiated identity, and can be consistently self-directed over long periods of time. They are aware of their limitations, exhibit self-compassion, and can take pride in their accomplishments. Emotionally, they are deeply connected with how they feel and are both aware and attuned to their emotional world while also able to adaptively regulate emotional expression in an effective way. Such individuals will tend to have a history of longstanding relationships built on trust, intimacy, and mutual respect. Under duress, these individuals are robust, meaning they are anti-fragile. They are not easily perturbed or reactive, do not become defensive when criticized, maintain their integrity, do not feel sorry for themselves, and, when faced with significant adversity, they demonstrate realistic hope and resilience.

2. Healthy-Neurotic

These individuals generally feel happy with themselves, have a reasonable sense of who they are, and can acknowledge weaknesses and take pride in their accomplishments. Emotionally, such individuals feel good when things are going well and take pleasure in life. They are generally aware of their feelings and not regularly overwhelmed. Typically, these folks maintain enduring relationships and are able to establish intimacy and reciprocity, especially when times are good. However, unlike healthy-resilient folks, these individuals do have significant character vulnerabilities and emotional and relational blind spots. Consequently, certain kinds of stressors can leave them feeling defensive, confused, hurt, or reactive.

3. Neurotic-Troubled

When things are going well, these individuals feel “ok” about life and themselves. They have a general sense of who they are, but it is fragile and fluctuates significantly depending on context and feedback. Many have a sense that they should do better or be more than they are, and often experience a sense of inferiority coupled with unrealistic personal standards.

Some compensate and present with an inflated self-appraisal to defend against their vulnerabilities. Strong emotions can be hard to regulate for these folks, and they are vulnerable to shame, guilt, and rage. They can have fairly primitive defense mechanisms, and their capacity for self-reflection may be diminished, especially when threatened. While they have the capacity and desire to form relationships, their connections may be superficial or fraught with conflict. Not uncommonly, relationships are based largely on meeting self-regulatory and self-esteem needs and begin with unrealistic expectations.

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These individuals often feel vulnerable, and when significant stressors emerge, they are not able to adjust in optimal ways. Instead, they reactively try to avoid or blame or engage in misguided control that tends to make the situation worse. These maladaptive cyclical patterns, coupled with high levels of trait neuroticism, make these individuals vulnerable to developing anxiety and depressive conditions or related impulse control problems like eating disorders.

4. Borderline-Dysfunctional

These individuals commonly feel confused and adrift. They often feel empty or vacillate between extremes in their sense of self, their emotions, and their relations with others. A dissertation on the core of borderline personality disorder summarized the structure as follows:

The dysfunctional polarization of emotional and relational modes, involving splitting extremes and a lack of integration at the internal narrative, social, and identity/worldview levels, that results in chronic patterns of maladaptive reactivity and impulsivity, stemming from a particular biosocial dynamic between a neurotic temperament and interpersonally wounding and invalidating environment.

The combination of intense emotionality, polarized needs, and a fractured identity results in erratic and often destructive and impulsive behavioral patterns. Under the best of circumstances, these folks can cope with their overwhelming emotionality and often can be charming or talented. However, under duress, which is not uncommon given their patterns of reactivity, their functioning can collapse. Depressive paralysis, panic attacks, explosive outbursts, excessive eating, drinking, sexual exploits, self-harm, and suicidal ideation or attempts are common.

5. Psychotic-Disorganized

This last category is a bit different. It represents a complete breakdown of reality testing and the inability to engage in day-to-day living. Complete withdrawal, delusions, hallucinations, disordered thinking, inability to hold a job or manage money, and highly unusual or unpredictable behavioral patterns characterize this level. The identity is shattered, and there are a host of cognitive and affective problems. This final category should probably be considered a different kind of pattern than the other four, in that it is probably better to characterize such states as breakdowns in the basic neurocognitive structures that afford contact with reality, rather than framing them as arising from longstanding developmental personality structural dynamics. But it is useful to include it here, as this is a continuum of functioning.

Conclusion

The goal here is to provide folks a way to think about personality functioning as the interrelationships between identity, emotional functioning, and relationships and to have clear descriptions that range from optimal/adaptive to chaotic and dysfunctional. In listing them, we want to be clear that individual humans are more than paragraph descriptions, and so we caution readers from thinking that it is easy to place people in one level or another. With that caveat, we believe it is a useful lens to have access to and that we need models that help us see both the adaptive and maladaptive aspects of identity, emotional functioning, and relationships.