Haltlose personality disorder
Haltlose personality disorder was a type of personality disorder diagnosis largely used in German-, Russian- and French-speaking countries, not dissimilar from Borderline Personality Disorder. The German word haltlos refers to being "unstable", and in English-speaking countries the diagnosis was sometimes referred to as "the unstable psychopath", although it was little known even among experts in psychiatry.
In the early twentieth century, haltlose personality disorder was described by Emil Kraepelin and Gustav Aschaffenburg. In 1905, Kraepelin first used the term to describe individuals possessing psychopathic traits built upon short-sighted selfishness and irresponsible hedonism, combined with an inability to anchor one's identity to a future or past. By 1913, he had characterized the symptomatology as stemming from a lack of inhibition. Haltlose was also characterized as a psychopathy with an "absence of intent or lack of will". The diagnosis was recognized by Karl Jaspers, and by Eugen and Manfred Bleuler, among others.
In 1933, it was argued that significant social restraints needed to be imposed on the lives of people diagnosed with haltlose personality disorder, including "constant guardianship in an organized environment under the pressure of a harsh lifestyle, or in the hands of a person with a strong will who does not let him out of his sight". In 1936, it was claimed that – along with other "hyperthymics" – haltlose personalities constituted "the main component of serious crime". Haltlose came to be studied as a type of psychopathy relevant to criminology, as people with the diagnosis were viewed as becoming "very easily involved in criminality" and predisposed to aggression or homicide.
Haltlose personality disorder was viewed as difficult to identify due to high levels of conformity. Contrasting traits were noted of pronounced suggestibility and "abnormal rigidity and intransigence and firmness". As recently as 1978, a claim was made that a diagnosis of haltlose personality disorder carried one of the most unfavorable prognoses among the different types of psychopathies recognized at the time.
Regarding recent medical classifications, the term "haltlose personality disorder" was mentioned in ICD-10 under "other specific personality disorders", and in DSM-III under "other personality disorders", but the term was not described or discussed in either classification. It is no longer mentioned in DSM-IV, DSM-5, or ICD-11.
Signs and symptoms
According to 1968 research, haltlose personality disorder is frequently comorbid with other mental health diagnoses, and rarely appears isolated on its own. Hans Heinze focused on his belief that Haltlose ultimately stemmed from a sense of inferiority, while Kramer held there was a battling inferiority complex and superiority complex.The Haltlose were said to have a dynamic instinctual drive to "cling" to others, to avoid a horrible loneliness they fear – but they will always represent a "lurking danger" because they were unable to actually maintain the necessary relationship and were in a class with the "forever abandoned". According to 1926 research, they view all interaction as a means of winning "indulgence from some people, help from other people".
One early study indicated that 7.5% of psychopaths were Haltlose, and Kraepelin estimated that his own practice determined fewer than 20% of psychopaths he saw were Haltlose. However, later studies, after differentiating out newer diagnoses, have suggested that it may be fewer than 1% of psychopaths who are truly Haltlose.
Described in 1922 as both "moody" and "passive", they quickly switch from over-confidence in victory to sullen defiance.
Their emotional lability means they alternate between projecting an optimistic and competent image claiming they are "destined to do great things", and a more honest cynicism and depression. Research in 1925 indicates they display "great emotional irritability, which may result in violent loss of temper...and interpret every limitation as an undeserved insult" and have a "pronounced lust for argument". The symptoms are considered to worsen if patients are granted greater independence "in the home and in their work".
Their self schema only encompasses the immediate present. They are described as "living in a random location and moment". A common pitfall in therapy is that they proved in 1917 to be "very superficial, they easily acquire knowledge but do not apply it in any way and soon forget it".
Those with HLPD display "a number of endearing qualities, charming with an apparent emotional warmth, but also an enhanced suggestibility and a superficiality of affect", which can lead to unrealistic optimism. and "wandering through life without ever taking firm root". They are also noted as "absolutely indifferent to others...likes to live for pleasure today, does not make plans not only for the future but even for tomorrow, studying and working are not for them". Persons with HLPD typically lack any deep knowledge, and "look for easy life and pleasures". They have been described as "conquerors with an appearance of emotional warmth".
Persons with HLPD were noted as struggling with hypochondria in 1907.
Kraepelin said they were "apt to take senseless journeys, perhaps even becoming vagabonds". Kraepelin argued only lifelong wanderlust was tied to Haltlose, whereas Kahn argued that the Haltlose often lost their wanderlust as they aged and preferred to settle into mediocrity. Some make their fortune, but the disappearance of less fortunate travelers is not mentioned by their families who considered them to have been burdensome.
To early twentieth-century researchers, they appeared amiable, well-spoken, self-confident and to be making strong efforts to improve their weaknesses, thus making a misleading first impression and endearing themselves to superiors. The lack of a sense of identity, or internal support, was thought to a lack of resistance to both external and internal impulses in 1927. Their "gradual deterioration in the swamp of neediness and immorality" still does not make a lasting impression on the patients. Thus Haltlose patients who recognize their shortcomings were thought to possibly be overwhelmed by a subconscious fear about participating in the world without restraints in a 1924 account. Similarly, researchers in the early twentieth-century believed that the inauthenticity of their projected self and superficiality of knowledge means that when "someone who is really superior to ", after a period of stiffly asserting themselves hoping to avoid submission, will ultimately and without explanation fully embrace the position of the other.
Pathological lying is closely linked to Haltlose personality disorder, with Arthur Kielholz noting "They lie like children...this activity always remains just a game which never satisfies them and leaves them with a guilty conscious because neither the super ego nor the Id get their due... Since they are offering such a daydream as a gift, they consider themselves entitled to extract some symbolic gift in return through fraud or theft". Adler maintained "Memory is usually poor and untrustworthy... often they seem to have no realization of the truth", while Homburger felt they held "no sense of objectivity, no need for truth or consistency".
According to early accounts, choices are made, often in mirroring others around them, but "do not leave even a passing imprint on the person's identity". Thus, they can "behave properly for a while under good leadership", and are not to be trusted in leadership positions themselves. Gannushkin noted they must be urged, scolded or encouraged "with a stick, as they say". They demonstrate poor mood control and "react quickly to immediate circumstances" since "mood variation can be extreme and fluctuate wildly", which led to the denotation "unstable psychopath".
They have been described as "cold-blooded", but must be differentiated from dependent personality disorder, as the two can appear similar, due to the artifice of the Haltlose patient, despite having starkly opposing foundations. Persons with Dependent Personality Disorder are defined by a tendency to embarrassment, and submissiveness which are not genuine facets of those with Haltlose even if they mimic such. Haltlose was thus deemed the "more troublesome" personality in 1955.
Consumption
People with haltlose personality disorder were found to struggle with alcoholism, and identify with antisocial personality disorder. Kraepelin, in noting "an increased risk of criminal behavior", estimated that 64% of men and 20% of women with Haltlose descended into alcoholism in the early twentieth century. The high observed correlation between haltlose personality disorder and alcoholism led to clinical researchers at the time using "haltlose" as a grouping when separating subjects by disposition.Research in 1915 noted an increased propensity for lavish spending, and overconsumption of coffee, tea and medication.
Sexual
One 1954 study suggested female Haltlose patients may experience "manic excitement" during their menses. According to 1949 research, they have a higher rate of homosexuality, and 1939 evidence suggested that masturbation is more prevalent in Haltlose and Gemütlose psychopaths than in other disorders, and Haltlose erethics leave them "usually very sexually excited" and seeking out "atypical, irregular and unusual" debauchery whether in brothels, adultery or destroying marriages.Causes
Fear
One proposed explanation for the development of haltlose personality disorder was fear. After discovering a guilty conscience due to some act or omission they have committed, "they then live under constant fear of the consequences of their action or inaction, fear of something bad that might strike them" in stark opposition to their apparent carelessness or hyperthymic temperament, which is itself frequently a subconscious reaction to overwhelming fear. Given their tendency to "exaggerate, to embroider their narratives, to picture themselves in ideal situations, to invent stories", this fear then manifests as being "apt to blame others for their offences, frequently seeking to avoid responsibility for their actions". They do not hold themselves responsible for their failed life, instead identifying as an ill-treated martyr.They were characterized as Dégénérés supérieurs, demonstrating normal or heightened intellect but degraded moral standards. Of the ten types of psychopaths defined by Schneider, only the Gemütlose and the Haltlose "had high levels of criminal behavior" without external influence, and thus made up the minority of psychopaths who are "virtually doomed to commit crimes" by virtue only of their own constitution. Frequently changing their determined goals, a haltlose psychopath is "constantly looking for an external hold, it doesn't really matter whether they join occult or fascist movements". The ability to moderate external influence was considered one of three characteristics necessary to form an overall personality, thus leaving Haltlose patients without a functional personality of their own. A study of those with haltlose personality disorder concludes "In all of those cases, the result was a continuous social decline that ended in asocial-parasitic existence or an antisocial-criminal life".