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Disorders of Personality—Rediscovered and Reconsidered

During the first half of the twentieth century, clinicians believed deeply in the unique, enduring patterns we call personality, and they tried to define important personality traits. They then discovered how readily people can be shaped by the situations in which they find themselves, and a backlash developed. The concept of personality seemed to lose legitimacy, and for a while it became almost an obscene word in some circles. The clinical category of personality disorders went through a similar rejection. When psychodynamic and humanistic theorists dominated the clinical field, neurotic character disorders—a set of diagnoses similar to today’s personality disorders—were considered useful clinical categories, but their popularity declined as other models grew in influence.

During the past 25 years, serious interest in personality and personality disorders has rebounded. In case after case, clinicians have concluded that rigid personality traits do seem to pose special problems, and they have developed new tests and interview guides to assess these disorders, setting in motion a wave of systematic research. So far, only the antisocial and borderline personality disorders have received much study. However, with DSM-5 now considering a new—dimensional—classification approach for possible use in the future, additional research is likely to follow. This may allow clinicians to better answer some pressing questions: How common are the various personality disorders? How useful are personality disorder categories? How effective is a dimensional approach to diagnosing these disorders? And which treatments are most effective?

One of the most important questions is, “Why do people develop troubled patterns of personality?” As you have read, psychological, as opposed to biological and sociocultural, theories have offered the most suggestions so far, but these explanations are not very precise and they do not have strong research support. Given the current enthusiasm for biological explanations, genetic and biological factors are beginning to receive considerable study, a shift in the waters that should soon enable researchers to determine possible interactions between biological and psychological causes. And one would hope that sociocultural factors will be studied as well. As you have seen, sociocultural theorists have only occasionally offered explanations for personality disorders, and multicultural factors have received little research. However, sociocultural factors may well play an important role in these disorders and certainly should be examined more carefully.

DSM-5’s proposal of a dimensional classification approach eventually may lead to major changes in the field’s understanding, diagnosis, and treatment of personality disorders. Now that clinicians have rediscovered personality disorders, they must determine the most appropriate ways to think about, explain, and treat them.