Anger impairs cognition. The angry person is a worried person. The Personality Disordered is also excessively preoccupied with himself. Worry and anger are the cornerstones of anxiety. This is where the knot is finally tied: people become angry because they are excessively concerned with bad things which might happen to them. Anger is a result of anxiety (or, when the anger is not acute, of fear).

Another striking similarity between anger and personality disorders is the deterioration of the faculty of empathy. Angry people cannot empathize. Actually, "counter-empathy" develops in a state of acute anger. Circumstances related to the source of the anger which, in a normal emotional state, would have been considered mitigating or empathy-inducing - are now taken to devalue and belittle the suffering of the angry person. They provoke anger rather than mollify it.

The anger of the personality disordered thus increases the more the victim presents with mitigating or empathy-inducing circumstances. Anger alters judgment. The seriousness of provocative acts, for instance, is judged by their chronological position. This is further compounded by the fact that an impairment of the capacity to empathize is a prime symptom in many of the personality disorders (in the Narcissistic, Schizoid, Antisocial, and Schizotypal Personality Disordered, for instance).

Moreover, the aforementioned impairment of judgment (i.e., impairment of the mechanism of risk assessment) appears in both acute anger and in many personality disorders. The illusion of omnipotence (power) and invulnerability, the partiality of judgment - are typical of both states.

Acute anger (rage attacks in personality disorders) is always incommensurate with the magnitude of the source of the emotion and is fuelled by extraneous experiences. An acutely angry person usually reacts to an accumulation, an amalgamation of aversive experiences, all enhancing each other in vicious feedback loops, many of them not directly related to the cause of the specific anger episode.

The angry person may be reacting to stress, agitation, disturbance, drugs, violence or aggression he witnessed, to social or to national conflict, to elation, and even to sexual excitation. The same is true of the Personality Disordered. His inner world is fraught with unpleasant, ego-dystonic, discomfiting, unsettling, and anxious experiences. His external environment - influenced and molded by his distorted personality - is also transformed into a source of aversive, repulsive, or plainly unpleasant experiences.

The personality Disordered explodes in rage because he both implodes and reacts to outside stimuli, simultaneously. Because he is prone to magical thinking and, therefore, regards himself as immune, omnipotent, omniscient and protected from the consequences of his own acts - the Personality Disordered often acts in a self destructive and self defeating manner. The similarities are so numerous and so striking that it seems safe to say that the Personality Disordered is in a constant state of acute anger.

Finally, acutely angry people perceive anger to have been the result of intentional (or circumstantial) provocation with a hostile purpose. Their targets, on the other hand, invariably regard them as incoherent people, acting arbitrarily, in an unjustified manner.

IV. Pathological Narcissism - The Root of Mental Illness

All personality disorders are interrelated, at least phenomenologically. We have no Grand Unifying Theory of Psychopathology. We do not know whether there are - and what are - the mechanisms underlying mental disorders. At best, mental health professionals register symptoms (as reported by the patient) and signs (as observed). Then, they group them into syndromes and, more specifically, into disorders. This is descriptive, not explanatory science. Psychological theories hitherto failed to provide a coherent, consistent theoretical framework with predictive powers.

Patients suffering from personality disorders have many things in common:

1. Most of them are insistent (except those suffering from the Schizoid or the Avoidant Personality Disorders). They demand treatment on a preferential and privileged basis. They complain about numerous symptoms. They never obey the physician or his treatment recommendations and instructions.
2. They regard themselves as unique, display a streak of grandiosity and a diminished capacity for empathy (the ability to appreciate and respect the needs and wishes of other people). They regard the physician as inferior to them, alienate him using umpteen techniques and bore him with their never-ending self-preoccupation.
3. They are manipulative and exploitative because they trust no one and usually cannot love or share. They are socially maladaptive and emotionally unstable.
4. Most personality disorders start out as problems in personal development which peak during adolescence and then become personality disorders. They remain as enduring qualities of the individual. Personality disorders are stable and all-pervasive - not episodic. They affect most of the areas of functioning of the patient: his career, his interpersonal relationships, his social interactions.
5. The patient is not happy. He is depressed, suffers from auxiliary mood and anxiety disorders. He does not like himself, his character, his (deficient) functioning, or his (crippling) influence on others. But his defences are so strong, that he is sometimes unaware of the distress, let alone its reasons.
6. The patient with a personality disorder is vulnerable to and prone to suffer from a host of other psychiatric disturbances ("co-morbidity". It is as though his psycho-immunological system has been disabled by his personality disorder and he falls prey to other variants of mental sickness. So much energy is consumed by the disorder and by its corollaries (obsessions-compulsions, depressive episodes), that the patient is utterly self-consumed by it.
7. Patients with personality disorders have alloplastic defences. In other words: they tend to blame the world for their mishaps. In stressful situations, they try to pre-empt a (real or imaginary) threats, change the rules of the game, introduce new variables, or otherwise influence the outside world to conform to their needs. This is as opposed to autoplastic defences exhibited, for instance, by neurotics (who change their internal psychological processes in stressful situations).
8. The character problems, behavioural deficits, emotional deficiencies, and instability (lability) displayed by patients with personality disorders are, mostly, ego-syntonic. This means that the patient does not, on the whole, find his personality traits or behaviour objectionable, unacceptable, disagreeable, or alien to his Self. As opposed to that, neurotics are ego-dystonic - they do not like who they are and how they behave.
9. The personality-disordered are not psychotic. They have no hallucinations, delusions or thought disorders (except those who suffer from the Borderline Personality Disorder and who experience brief psychotic "micro-episodes", mostly during treatment). They are also fully oriented, with clear senses (sensorium), good memory and a general fund of knowledge.