13.8 Personality Disorders
LO 10 Differentiate between antisocial and borderline personality disorders.
Before reading this chapter, you probably knew something about depression, bipolar disorder, and schizophrenia. But you may have been less familiar with a somewhat common group of disorders relating to personality. Approximately 1 in 10 adults in the United States has a personality disorder (Lenzenweger, Lane, Loranger, & Kessler, 2007). People with personality disorders exhibit “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment” (APA, 2013, p. 645). Specifically, someone with a personality disorder exhibits behaviors that deviate substantially in the following areas: (1) cognition, including perceptions of self, others, and events; (2) emotional responses; (3) interpersonal functioning; and (4) impulse control. In order to be diagnosed with a personality disorder, one must struggle in at least two of these four categories. In addition, these problems must be resistant to change and have far-reaching consequences for interpersonal relationships.
Like personality traits in general, the core qualities of people with personality disorders (as well as the problems that result) are fairly stable over a lifetime and across situations. When diagnosing this type of disorder, the clinician must focus on troublesome personality traits—and be very careful not to confuse them with problems resulting from developmental changes, culture, drug use, or medical conditions.
The DSM–5 includes 10 personality disorder types (TABLE 13.9). Here, we direct the spotlight onto those that have received the greatest amount of research attention: antisocial personality disorder and borderline personality disorder.
| Personality Disorder | Explanation |
|---|---|
| Paranoid | Widespread distrust of others without basis |
| Schizoid | Detachment from relationships and a limited range of emotional expression |
| Schizotypal | Difficulty in establishing relationships, limited ability to maintain close relationships, and eccentric or strange behavior |
| Antisocial | Unethical behavior, deceitful, impulsive, irritable, aggressive, disregard for others, lack of remorse |
| Borderline | Incomplete sense of self, extreme self-criticism, unstable emotions, and feelings of emptiness |
| Histrionic | Extreme emotions used to gain attention |
| Narcissistic | Self-absorbed, needs to be admired, lack of empathy |
| Avoidant | Social self-consciousness, hypersensitive to negative feedback |
| Dependent | Clingy, needs to be cared for by others |
| Obsessive-compulsive | Fixation with order, perfection, and control |
| Listed above are the 10 personality disorders identified by the DSM–5. | |
| SOURCE: DSM–5 (AMERICAN PSYCHIATRIC ASSOCIATION, 2013). | |
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Antisocial Personality Disorder
Many films, including The Girl with the Dragon Tattoo and The Silence of the Lambs, feature characters who behave in ways most people find incomprehensible. The qualities of these characters often parallel a diagnosis of antisocial personality disorder.
People with antisocial personality disorder may seek personal gratification even when it means violating ethical standards and breaking laws. They sometimes lie or con others, and exhibit aggressive, impulsive, or irritable behaviors. These individuals have difficulty feeling empathy, and may not show concern for others or feel remorse upon hurting them. Other common behavior patterns include carelessness in sexual relationships, and the use of intimidation to control others (APA, 2013). Around 1% of American adults are diagnosed with antisocial personality disorder, which is more common in men than women (Lenzenweger et al., 2007).
How does antisocial personality disorder develop? There is some evidence for family risk factors, but it is unclear how much of this risk is transmitted through genes, and how much results from learning. Heredity does appear to play a role, as first-degree biological relatives of people with antisocial personality disorder are more likely to have the disorder than those in the general population (APA, 2013). However, no single gene has been implicated in the development of antisocial behavior patterns. Like most mental health problems, antisocial personality disorder seems to result from a complex interaction of genes and environment (Ferguson, 2010).
You may be wondering what is unique about the brain of a person with antisocial personality disorder. Some studies point to irregularities in the frontal lobes, a region of the brain that is crucial for executive functioning. For example, reduced tissue volume in the prefrontal cortex (11% less than expected) is apparent in some men with antisocial personality disorder. This deficit might be linked to problems in decision making, planning, reduced morality, and difficulties with learning in relation to fear, all potentially associated with antisocial behavior. The fact that the prefrontal cortex plays a role in controlling arousal may explain why people with this disorder tend to seek out stimulation, including aggressive and antisocial activities (Raine, Lencz, Bihrle, LaCasse, & Colletti, 2000).
CONNECTIONS
In Chapter 7, we noted that executive functioning is involved in planning, maintaining focus, and suppressing automatic responses. In Chapter 2, we learned that the frontal lobes are critical in processing emotions and controlling impulses. If these areas in the brain are not functioning properly, one may exhibit antisocial behavior.
Borderline Personality Disorder
Another personality disorder commonly portrayed in movies is borderline personality disorder. If you have seen Black Swan, you may remember the emotionally unstable, intense, and extremely needy Beth Macintyre. If Beth were a real person, she might fit the diagnostic criteria for borderline personality disorder, which is distinguished by an incomplete sense of self and feelings of emptiness. People with this disorder may exhibit intense anger, have difficulty controlling their temper, and get into physical fights. They can be impulsive when it comes to sexual activity, substance abuse, and spending money, and may threaten or attempt suicide on a recurring basis. Developing intimacy may also be a struggle, and relationships tend to be unstable, tainted with feelings of mistrust and the fear of being abandoned. Those with borderline personality disorder may see the world in terms of black and white, rather than different shades of gray. This tendency to perceive extremes may lead a person to become overinvolved or totally withdrawn in relationships (APA, 2013).
According to DSM–5, individuals with borderline personality disorder experience emotions that are unstable, intense, and inappropriate for the situation at hand. They may feel extreme anxiety and insecurity, concern about being rejected one moment, worried about being too dependent the next. Depressed moods are common, along with feelings of hopelessness, pessimism, and shame. The person may act without thinking and frequently change plans.
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Seventy-five percent of people diagnosed with borderline personality disorder are female, and research suggests that some traits associated with this disorder have a genetic component (APA, 2013). There is also evidence that childhood trauma sets the stage for the development of this condition. A biosocial developmental model has been proposed, indicating an early vulnerability that includes impulsive behavior and increased “emotional sensitivity.” If the environment is right, this susceptibility can lead to problems with emotions, behaviors, and cognitive processes (Crowell, Beauchaine, & Linehan, 2009).
As you now know, personality disorders stem from well-established personality characteristics. People suffering from these disorders have traits that are relatively easy to characterize. This is not the case for people with dissociative disorders, whose personal identities may be very difficult to pin down.
show what you know
Question 13.23
1. The personality disorders include impairments concerning
- contact with reality.
- manic episodes.
- developmental processes.
- the self and interpersonal relationships.
Question 13.24
2. Individuals with ____________ are likely to feel a sense of emptiness, likely to become angry easily, and maintain intense but unstable relationships.
Question 13.25
3. Two of the identifiers of abnormal behavior are distress and impairment. How would the personality disorders fit the criteria for abnormal behavior?
CHECK YOUR ANSWERS IN APPENDIX C.