Jump to content

Asociality

From Wikipedia, the free encyclopedia
(Redirected from Unsocial)

Asociality refers to the lack of motivation to engage in social interaction, or a preference for solitary activities. Asociality may be associated with avolition, but it can, moreover, be a manifestation of limited opportunities for social relationships.[1] Developmental psychologists use the synonyms nonsocial, unsocial, and social uninterest. Asociality is distinct from, but not mutually exclusive to, anti-social behavior. A degree of asociality is routinely observed in introverts, while extreme asociality is observed in people with a variety of clinical conditions.

Asociality is not necessarily perceived as a totally negative trait by society, since asociality has been used as a way to express dissent from prevailing ideas. It is seen as a desirable trait in several mystical and monastic traditions, notably in Hinduism, Jainism, Roman Catholicism, Eastern Orthodoxy, Buddhism[2][3][4][5][6] and Sufism.[7]

Introversion

[edit]

Introversion is "the state of or tendency toward being wholly or predominantly concerned with and interested in one's own mental life."[8] Introverted persons are considered the opposite of extraverts, who seem to thrive in social settings rather than being alone. An introvert may present as an individual preferring being alone or interacting with smaller groups over interaction with larger groups, writing over speaking, having fewer but more fulfilling friendships, and needing time for reflection.[9] While not a measurable personality trait, some popular writers have characterized introverts as people whose energy tends to expand through reflection and dwindle during interaction.[10]

In matters of the brain, researchers have found differences in anatomy between introverted and extraverted persons.[9] Introverted people are found to experience a higher flow of blood to the frontal lobe than extraverts, which is the part of the brain that contributes to problem-solving, memory, and preemptive thought.[9]

Social anhedonia

[edit]

Social anhedonia is found in both typical and extreme cases of asociality or personality disorders that feature social withdrawal. Social anhedonia is distinct from introversion and is frequently accompanied with alexithymia.[11]

Many cases of social anhedonia are marked by extreme social withdrawal and the complete avoidance of social interaction.[12] One research article studying the individual differences in social anhedonia[13][14] discusses the negative aspects of this form of extreme or aberrant asociality. Some individuals with social anhedonia are at higher risk of developing schizophrenia and may have mental functioning that becomes poorer than the average.[13]

In human evolution and anthropology

[edit]

Scientific research suggests that asocial traits in human behavior, personality, and cognition may have several useful evolutionary benefits. Traits of introversion and aloofness can protect an individual from impulsive and dangerous social situations because of reduced impulsivity and reward.[15] Frequent voluntary seclusion stimulates creativity and can give the individual time to think, work, reflect, and see useful patterns more easily.[16]

Research indicates the social and analytical functions of the brain function in a mutually exclusive way.[17] With this in mind, researchers posit that people who devoted less time or interest to socialization used the analytical part of the brain more frequently and thereby were often responsible for devising hunting strategies, creating tools, and spotting useful patterns in the environment in general for both their own safety and the safety of the group.[18][19][20]

Imitation and social learning have been confirmed to be potentially limiting and maladaptive in animal and human populations.[21] When social learning overrides personal experience (asocial learning), negative effects can be observed such as the inability to seek or pick the most efficient way to accomplish a task[22] and a resulting inflexibility to changing environments.[23][24] Individuals who are less receptible, motivated, and interested in sociability are likely less affected by or sensible to socially imitated information[25] and faster to notice and react to changes in the environment,[26][27] essentially holding onto their own observations in a rigid manner and, consequently, not imitating a maladaptive behavior through social learning. These behaviors, including deficits in imitative behavior, have been observed in individuals with autism spectrum disorders[20][28][29] and introverts,[30] and are correlated with the personality traits of neuroticism and disagreeableness.[25]

The benefits of this behavior for the individual and their kin caused it to be preserved in part of the human population. The usefulness for acute senses,[31] novel discoveries, and critical analytical thought[32] may have culminated in the preservation of the suspected genetic factors of autism and introversion itself due to their increased cognitive, sensorial, and analytical awareness.[33][34]

In psychopathology

[edit]

Schizophrenia

[edit]

In schizophrenia, asociality is one of the main five "negative symptoms", with the others being avolition, anhedonia, reduced affect, and alogia. Due to a lack of desire to form relationships, social withdrawal is common in people with schizophrenia.[35][36][37] People with schizophrenia may experience social deficits or dysfunction as a result of the disorder, leading to asocial behavior. Frequent or ongoing delusions and hallucinations can deteriorate relationships and other social ties, isolating individuals with schizophrenia from reality and in some cases leading to homelessness. Even when treated with medication for the disorder, they may be unable to engage in social behaviors. These behaviors include things like maintaining conversations, accurately perceiving emotions in others, or functioning in crowded settings. There has been extensive research on the effective use of social skills training (SST) for the treatment of schizophrenia, in outpatient clinics as well as inpatient units. SST can be used to help patients with schizophrenia make better eye contact with other people, increase assertiveness, and improve their general conversational skills.[38]

Personality disorders

[edit]

Avoidant personality disorder

[edit]

Asociality is common amongst people with avoidant personality disorder (AvPD). They experience discomfort and feel inhibited in social situations, being overwhelmed by feelings of inadequacy. Such people remain consistently fearful of social rejection, choosing to avoid social engagements as they do not want to give people the opportunity to reject (or possibly, accept) them. Though they inherently crave a sense of belonging, their fear of criticism and rejection leads people with AvPD to actively avoid occasions that require social interaction, leading to extremely asocial tendencies; as a result, these individuals often have difficulty cultivating and preserving close relationships.[39]

People with AvPD may also display social phobia, the difference being that social phobia is the fear of social circumstances whereas AvPD is better described as an aversion to intimacy in relationships.[40]

Schizoid personality disorder

[edit]

Schizoid personality disorder (SzPD) is characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and apathy. Affected individuals may simultaneously demonstrate a rich and elaborate but exclusively internal fantasy world.[41]

It is not the same as schizophrenia, although they share such similar characteristics as detachment and blunted affect. There is, moreover, increased prevalence of the disorder in families with schizophrenia.[42]

Schizotypal personality disorder

[edit]

Schizotypal personality disorder is characterized by a need for social isolation, anxiety in social situations, odd behavior and thinking, and often unconventional beliefs. People with this disorder feel extreme discomfort with maintaining close relationships with people, and therefore they often do not. People who have this disorder may display peculiar manners of talking and dressing and often have difficulty in forming relationships. In some cases, they may react oddly in conversations, not respond, or talk to themselves.[43]

Autism

[edit]

Autistic people may display profoundly asocial tendencies, due to differences in how autistic and allistic (non-autistic) people communicate. These different communication styles can cause mutual friction between the two neurotypes,[44] known as the double empathy problem. Autistic people tend to express emotions differently and less intensely than allistic people, and often do not pick up on allistic social cues or linguistic pragmatics (including eye contact, facial expressions, tone of voice, body language, and implicatures) used to convey emotions and hints.

Connecting with others is important to overall health. An increased difficulty in accurately reading social cues by others can affect this desire for people with autism. The risk of adverse social experiences is high for those with autism, and so they may prefer to be avoidant in social situations rather than experience anxiety over social performance. Social deficits in people with autism is directly correlated with the increased prevalence of social anxiety in this community.[45] As they are in a steep minority, there is risk of not having access to like-minded peers in their community, which can lead them to withdrawal and social isolation.

Mood disorders

[edit]

Depression

[edit]

Asociality can be observed in individuals with major depressive disorder or dysthymia, as individuals lose interest in everyday activities and hobbies they used to enjoy, this may include social activities, resulting in social withdrawal and withdrawal tendencies.[46]

SST can be adapted to the treatment of depression with a focus on assertiveness training. Depressed patients often benefit from learning to set limits with others, to obtain satisfaction for their own needs, and to feel more self-confident in social interactions. Research suggests that patients who are depressed because they tend to withdraw from others can benefit from SST by learning to increase positive social interactions with others instead of withdrawing from social interactions.[47]

Social anxiety disorder

[edit]

Asocial behavior is observed in people with social anxiety disorder (SAD), who experience perpetual and irrational fears of humiliating themselves in social situations. They often have panic attacks and severe anxiety as a result, which can occasionally lead to agoraphobia. The disorder is common in children and young adults, diagnosed on average between the ages of 8 and 15.[48] If left untreated, people with SAD exhibit asocial behavior into adulthood, avoiding social interactions and career choices that require interpersonal skills. SST can help people with social phobia or shyness to improve their communication and social skills so that they will be able to mingle with others or go to job interviews with greater ease and self-confidence.[49]

Traumatic brain injury

[edit]

Traumatic brain injuries (TBI) can also lead to asociality and social withdrawal.[50]

Management

[edit]

Treatments

[edit]

Social skills training

[edit]

Social skills training (SST) is an effective technique aimed towards anyone with "difficulty relating to others," a common symptom of shyness, marital and family conflicts, or developmental disabilities; as well as of many mental and neurological disorders including adjustment disorders, anxiety disorders, attention-deficit/hyperactivity disorder, social phobia, alcohol dependence, depression, bipolar disorder, schizophrenia, avoidant personality disorder, paranoid personality disorder, obsessive-compulsive disorder, and schizotypal personality disorder.

Fortunately for people who display difficulty relating to others, social skills can be learned, as they are not simply inherent to an individual's personality or disposition. Therefore, there is hope for anyone who wishes to improve their social skills, including those with psychosocial or neurological disorders. Nonetheless, it is important to note that asociality may still be considered neither a character flaw nor an inherently negative trait.

SST includes improving eye contact, speech duration, frequency of requests, and the use of gestures, as well as decreasing automatic compliance to the requests of others. SST has been shown to improve levels of assertiveness (positive and negative) in both men and women.

Additionally, SST can focus on receiving skills (e.g. accurately perceiving problem situations), processing skills (e.g. considering several response alternatives), and sending skills (delivering appropriate verbal and non-verbal responses).[51]

Metacognitive interpersonal therapy

[edit]

Metacognitive interpersonal therapy is a method of treating and improving the social skills of people with personality disorders that are associated with asociality. Through metacognitive interpersonal therapy, clinicians seek to improve their patients' metacognition, meaning the ability to recognize and read the mental states of themselves. The therapy differs from SST in that the patient is trained to identify their own thoughts and feelings as a means of recognizing similar emotions in others. Metacognitive interpersonal therapy has been shown to improve interpersonal and decision-making skills by encouraging awareness of suppressed inner states, which enables patients to better relate to other people in social environments.

The therapy is often used to treat patients with two or more co-occurring personality disorders, commonly including obsessive-compulsive and avoidant behaviors.[52]

Coping mechanisms

[edit]

In order to cope with asocial behavior, many individuals, especially those with avoidant personality disorder, develop an inner world of fantasy and imagination to entertain themselves when feeling rejected by peers. Asocial people may frequently imagine themselves in situations where they are accepted by others or have succeeded at an activity. Additionally, they may have fantasies relating to memories of early childhood and close family members.[53]

See also

[edit]

References

[edit]
  1. ^ American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association. p. 88. CiteSeerX 10.1.1.988.5627. doi:10.1176/appi.books.9780890425596. ISBN 978-0-8904-2554-1.
  2. ^ Chrysostomos, Bishop; Akakios, Archimandrite (November 1991). "The old calendarists: A social psychological profile of a Greek Orthodox minority". Pastoral Psychology. 40 (2): 83–91. doi:10.1007/BF01040490. ISSN 0031-2789. S2CID 144654988.
  3. ^ Eisenstadt, S. N.; Shulman, D.; Kahane, R., eds. (1984). Orthodoxy, Heterodoxy and Dissent in India. De Gruyter. doi:10.1515/9783110852561. ISBN 978-3-1100-9659-0.
  4. ^ Michelson, Patrick Lally (2017). Beyond the monastery walls: the ascetic revolution in Russian Orthodox thought, 1814–1914. Madison, WI: University of Wisconsin Press. ISBN 978-0-2747-2870-1.
  5. ^ Silber, Ilana Friedrich (December 1981). "Dissent through Holiness: The Case of the Radical Renouncer in Theravada Buddhist Countries". Numen. 28 (2): 164–193. doi:10.2307/3270017. JSTOR 3270017.
  6. ^ Luehrmann, Sonja (2018). Praying with the Senses : Contemporary Eastern Orthodox Spirituality in Practice. Bloomington, IN: Indiana University Press. ISBN 978-0-253-03167-9. OCLC 1013820687.
  7. ^ Akaev, V.Kh.; Abdulaeva, Z.E. (2020). "Saving the Ethnocultural Heritage of the Peoples of the North Caucasus as an Alternative to Asocial Manifestations". Science Almanac of Black Sea Region Countries. 22 (2): 50–58. doi:10.23947/2414-1143-2020-22-2-50-58. ISSN 2414-1143. S2CID 226588791.
  8. ^ "Definition of introversion". Merriam-Webster. Retrieved June 25, 2016.
  9. ^ a b c Ellis, Rachel Reiff. "How to Tell if You're an Introvert". WebMD. Retrieved March 1, 2023.
  10. ^ Helgoe, Laurie A. (2013). Introvert power : why your inner life is your hidden strength (2nd ed.). Naperville, IL: Sourcebooks. ISBN 978-1-4022-8088-7. OCLC 818985487.
  11. ^ Martin, Elizabeth (2016). "Social Anhedonia is Not Just Extreme Introversion: Empirical Evidence of Distinct Constructs" (PDF). Journal of Personality Disorders. 30 (4): 451–468. doi:10.1521/pedi_2015_29_203. PMID 26067156.
  12. ^ "APA Dictionary of Psychology". dictionary.apa.org. Retrieved May 3, 2023.
  13. ^ a b Silvia, Paul J.; Kwapil, Thomas R. (December 2011). "Aberrant Asociality: How Individual Differences in Social Anhedonia Illuminate the Need to Belong: Social Anhedonia". Journal of Personality. 79 (6): 1315–1332. doi:10.1111/j.1467-6494.2010.00702.x. PMID 21480908.
  14. ^ Tan, Melody; Shallis, Amy; Barkus, Emma (April 2020). "Social anhedonia and social functioning: Loneliness as a mediator". PsyCh Journal. 9 (2): 280–289. doi:10.1002/pchj.344. ISSN 2046-0260. PMID 31965741. S2CID 210870966.
  15. ^ Gurven, Michael; von Rueden, Christopher; Stieglitz, Jonathan; Kaplan, Hillard; Rodriguez, Daniel Eid (January 1, 2014). "The evolutionary fitness of personality traits in a small-scale subsistence society". Evolution and Human Behavior. 35 (1): 17–25. doi:10.1016/j.evolhumbehav.2013.09.002. PMC 3885165. PMID 24415896.
  16. ^ Bowker, Julie C.; Stotsky, Miriam T.; Etkin, Rebecca G. (December 1, 2017). "How BIS/BAS and psycho-behavioral variables distinguish between social withdrawal subtypes during emerging adulthood". Personality and Individual Differences. 119: 283–288. doi:10.1016/j.paid.2017.07.043. ISSN 0191-8869.
  17. ^ Falk, Emily B.; Morelli, Sylvia A.; Welborn, B. Locke; Dambacher, Karl; Lieberman, Matthew D. (July 1, 2013). "Creating Buzz: The Neural Correlates of Effective Message Propagation". Psychological Science. 24 (7): 1234–1242. doi:10.1177/0956797612474670. ISSN 0956-7976. PMID 23722983. S2CID 225695.
  18. ^ Baron-Cohen, Simon (2020). The pattern seekers : how autism drives human invention (1st ed.). New York: Basic Books. ISBN 978-1-5416-4714-5. OCLC 1155485628.
  19. ^ Spikins, Penny; Wright, Barry (2016). The prehistory of autism (1st ed.). Rounded Globe.
  20. ^ a b Spikins, Penny; Wright, Barry; Hodgson, Derek (October 1, 2016). "Are there alternative adaptive strategies to human pro-sociality? The role of collaborative morality in the emergence of personality variation and autistic traits". Time and Mind. 9 (4): 289–313. doi:10.1080/1751696X.2016.1244949. ISSN 1751-696X. S2CID 151820168.
  21. ^ Kendal, Rachel L.; Coolen, Isabelle; van Bergen, Yfke; Laland, Kevin N. (January 1, 2005), Trade‐Offs in the Adaptive Use of Social and Asocial Learning, Advances in the Study of Behavior, vol. 35, Academic Press, pp. 333–379, doi:10.1016/s0065-3454(05)35008-x, ISBN 9780120045358, retrieved November 9, 2021
  22. ^ Laland, Kevin N.; Williams, Kerry (1998). "Social transmission of maladaptive information in the guppy". Behavioral Ecology. 9 (5): 493–499. doi:10.1093/beheco/9.5.493.
  23. ^ Kendal, Jeremy; Giraldeau, Luc-Alain; Laland, Kevin (September 21, 2009). "The evolution of social learning rules: Payoff-biased and frequency-dependent biased transmission". Journal of Theoretical Biology. 260 (2): 210–219. Bibcode:2009JThBi.260..210K. doi:10.1016/j.jtbi.2009.05.029. ISSN 0022-5193. PMID 19501102. S2CID 26547640.
  24. ^ Johnstone, R. A.; Dall, S. R. X.; Giraldeau, Luc–Alain; Valone, Thomas J.; Templeton, Jennifer J. (November 29, 2002). "Potential disadvantages of using socially acquired information". Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences. 357 (1427): 1559–1566. doi:10.1098/rstb.2002.1065. PMC 1693065. PMID 12495513.
  25. ^ a b Oyibo, Kiemute; Vassileva, Julita (September 2019). "The relationship between personality traits and susceptibility to social influence". Computers in Human Behavior. 98: 174–188. doi:10.1016/j.chb.2019.01.032. S2CID 150979344.
  26. ^ Boterberg, Sofie; Warreyn, Petra (April 2016). "Making sense of it all: The impact of sensory processing sensitivity on daily functioning of children". Personality and Individual Differences. 92: 80–86. doi:10.1016/j.paid.2015.12.022. hdl:1854/LU-7172755.
  27. ^ Aron, Elaine N. (February 2, 2012). "Time Magazine: "The Power of (Shyness)" and High Sensitivity". Psychology Today. Retrieved November 9, 2021.
  28. ^ Marsh, L.; Pearson, A.; Ropar, D.; Hamilton, A. (April 8, 2013). "Children with autism do not overimitate". Current Biology. 23 (7): R266–R268. doi:10.1016/j.cub.2013.02.036. hdl:1983/87f3cee8-3429-4afe-acc9-09f4c1ef82a3. ISSN 0960-9822. PMID 23578869. S2CID 1817284.
  29. ^ Morris, Barry K. (2008). "Aspergers & interpersonal relationships". www.autism-help.org. Retrieved April 12, 2023.
  30. ^ Freyd, M. (1924). "Introverts and Extroverts". Psychological Review. 31 (1): 74–87. doi:10.1037/h0075875. ISSN 1939-1471.
  31. ^ Takahashi, Hidetoshi; Nakahachi, Takayuki; Komatsu, Sahoko; Ogino, Kazuo; Iida, Yukako; Kamio, Yoko (March 12, 2014). "Hyperreactivity to weak acoustic stimuli and prolonged acoustic startle latency in children with autism spectrum disorders". Molecular Autism. 5 (1): 23. doi:10.1186/2040-2392-5-23. ISSN 2040-2392. PMC 4008133. PMID 24618368.
  32. ^ Soulières, Isabelle; Dawson, Michelle; Samson, Fabienne; Barbeau, Elise B.; Sahyoun, Chérif P.; Strangman, Gary E.; Zeffiro, Thomas A.; Mottron, Laurent (December 2009). "Enhanced visual processing contributes to matrix reasoning in autism". Human Brain Mapping. 30 (12): 4082–4107. doi:10.1002/hbm.20831. PMC 2787806. PMID 19530215.
  33. ^ Polimanti, Renato; Gelernter, Joel (February 10, 2017). "Widespread signatures of positive selection in common risk alleles associated to autism spectrum disorder". PLOS Genetics. 13 (2): e1006618. doi:10.1371/journal.pgen.1006618. ISSN 1553-7404. PMC 5328401. PMID 28187187.
  34. ^ Crespi, Bernard J. (2016). "Autism As a Disorder of High Intelligence". Frontiers in Neuroscience. 10: 300. doi:10.3389/fnins.2016.00300. ISSN 1662-453X. PMC 4927579. PMID 27445671.
  35. ^ Carson, Verna Benner (2000). Mental health nursing : the nurse-patient journey (2nd ed.). Philadelphia, PA: W.B. Saunders. p. 638. ISBN 978-0-7216-8053-8. OCLC 41528003.
  36. ^ Hirsch, Steven R.; Weinberger, Daniel R. (2003). Schizophrenia (2nd ed.). Malden, Mass.: Blackwell Science. p. 481. ISBN 978-0-6320-6388-8. OCLC 50803907.
  37. ^ Velligan, Dawn I.; Alphs, Larry D. (March 1, 2008). "Negative Symptoms in Schizophrenia: The Importance of Identification and Treatment". Psychiatric Times. 25 (3).
  38. ^ Comer, R. J. (2007). Abnormal Psychology (6th ed.). New York, NY: Worth Publishers.
  39. ^ American Psychological Association (2015). VandenBos, Gary R. (ed.). APA dictionary of psychology (2nd ed.). Washington, DC. ISBN 978-1-4338-1944-5. OCLC 898086816.{{cite book}}: CS1 maint: location missing publisher (link)
  40. ^ Comer, R. J. (2007). Abnormal Psychology (7th ed.). New York, NY: Worth Publishers.
  41. ^ Reber, Arthur S. (1995). The Penguin dictionary of psychology (2nd ed.). London: Penguin Books. p. 690. ISBN 978-0-1405-1280-9. OCLC 35002089.
  42. ^ Ball, Jeff. "Schizoid Personality Disorder". Psychological Care & Healing Treatment Center. Archived from the original on August 24, 2010. Retrieved December 18, 2010.
  43. ^ Schacter, Daniel L.; Gilbert, Daniel Todd; Wegner, Daniel M. (2011). Psychology (2nd ed.). New York, NY: Worth Publishers. ISBN 978-1-4292-3719-2. OCLC 755079969.
  44. ^ Crompton, Catherine J.; Hallett, Sonny; Ropa, Danielle (March 2020). "'I Never Realised Everybody Felt as Happy as I Do When I Am Around Autistic People': A Thematic Analysis of Autistic Adults' Relationships With Autistic and Neurotypical Friends and Family". Autism: The International Journal of Research and Practice. 24 (6): 1438–1448. doi:10.1177/1362361320908976. PMC 7376620. PMID 32148068.
  45. ^ Espelöer, J.; Hellmich, M.; Vogeley, K.; Falter-Wagner, C. M. (January 2021). "Brief Report: Social Anxiety in Autism Spectrum Disorder is Based on Deficits in Social Competence". Journal of Autism and Developmental Disorders. 51 (1): 315–322. doi:10.1007/s10803-020-04529-w. ISSN 0162-3257. PMC 7810630. PMID 32410100.
  46. ^ Harris, Rebecca Arden (September 15, 2014). "Chronic pain, social withdrawal, and depression". Journal of Pain Research. 7: 555–556. doi:10.2147/JPR.S71292. ISSN 1178-7090. PMC 4168867. PMID 25246807.
  47. ^ "Social skills training". Encyclopedia of Mental Disorders. Retrieved May 13, 2016.
  48. ^ "What Is Social Anxiety?". Child Mind Institute. Retrieved January 20, 2023.
  49. ^ Schneier, Franklin; Goldmark, Julia (2015), Stein, Dan J.; Vythilingum, Bavi (eds.), "Social Anxiety Disorder", Anxiety Disorders and Gender, Cham: Springer International Publishing, pp. 49–67, doi:10.1007/978-3-319-13060-6_3, ISBN 978-3-319-13059-0, retrieved January 20, 2023
  50. ^ Baulkman, Jaleesa (April 10, 2014). "Brain Injuries Can Make Children Loners". UniversityHerald. Retrieved June 25, 2016.
  51. ^ Morrison, Randall L.; Wixted, John T. (1989), Bellack, Alan S. (ed.), "Social Skills Training", A Clinical Guide for the Treatment of Schizophrenia, Boston, MA: Springer US, pp. 237–261, doi:10.1007/978-1-4757-8979-9_10, ISBN 978-1-4757-8981-2, retrieved April 12, 2023
  52. ^ Fiore, D.; Dimaggio, G.; Nicolo G.; Semerari, A. & Carcione, A. (2008). "Metacognitive Interpersonal Therapy in a Case of Obsessive–Compulsive and Avoidant Personality Disorders". Journal of Clinical Psychology. 64 (2): 168–180. doi:10.1002/jclp.20450. PMID 18186113.
  53. ^ Millon, Theodore; Millon, Carrie M.; Meagher, Sarah E.; Grossman, Seth D.; Ramnath, Rowena (2004). Personality disorders in modern life (2nd ed.). Hoboken, NJ: Wiley. ISBN 978-0-4712-3734-1. OCLC 57291241.

Further reading

[edit]