Approximate reading time: 26 minutes

The term personality refers loosely to one’s stable, consistent, and distinctive way of thinking about, feeling, acting, and relating to the world. People with personality disorders exhibit a personality style that differs markedly from the expectations of their culture, is pervasive and inflexible, begins in adolescence or early adulthood, and causes distress or impairment (APA, 2013). Generally, individuals with these disorders exhibit enduring personality styles that are extremely troubling and often create problems for them and those with whom they come into contact. Their maladaptive personality styles frequently bring them into conflict with others, disrupt their ability to develop and maintain social relationships, and prevent them from accomplishing realistic life goals.

The DSM-5 recognises 10 personality disorders, organised into 3 different clusters.

Cluster A disorders include people who display a personality style that is odd or eccentric:

• paranoid personality disorder
• schizoid personality disorder
• schizotypal personality disorder

 Cluster B disorders include people who are impulsive, overly dramatic, highly emotional, and erratic:

• antisocial personality disorder
• histrionic personality disorder
• narcissistic personality disorder
• borderline personality disorder

Cluster C disorders include people who often appear to be nervous and fearful:

• avoidant personality disorder
• dependent personality disorder
• obsessive-compulsive personality disorder (which is not the same thing as obsessive-compulsive disorder).

Table PD.2 provides a description of each of the DSM-5 personality disorders:

Slightly over 9% of the US population suffers from a personality disorder, with avoidant and schizoid personality disorders the most frequent (Lezenweger, Lane, Loranger, & Kessler, 2007). Two of these personality disorders, borderline personality disorder and antisocial personality disorder, are regarded by many as especially problematic.

Borderline Personality Disorder

The “borderline” in borderline personality disorder was originally coined in the late 1930s in an effort to describe patients who appeared anxious but were prone to brief psychotic experiences; that is, patients who were thought to be literally on the borderline between anxiety and psychosis (Freeman, Stone, Martin, & Reinecke, 2005). Today, borderline personality disorder has a completely different meaning.

The term “borderline” in Borderline Personality Disorder (BPD) has historical roots and reflects the initial conceptualization of the disorder. When the term was first introduced, it described a condition thought to lie on the “borderline” between neurosis and psychosis. Today, BPD is better understood and is no longer viewed in this way, but the term has persisted.

Borderline personality disorder is characterised chiefly by instability in interpersonal relationships, self-image, and mood, as well as marked impulsivity (APA, 2013). As for boundaries, individuals with BPD often struggle with identity and interpersonal boundaries. They may have difficulty distinguishing their own needs and emotions from those of others. This can manifest in several ways:

1. Identity Disturbance: Individuals with BPD may have an unstable sense of self, making it hard for them to establish clear personal boundaries.
2. Interpersonal Relationships: They often experience intense and unstable relationships. Their sense of self can be heavily influenced by their interactions with others, leading to difficulties in maintaining consistent boundaries.
3. Emotional Dysregulation: People with BPD may have intense and rapidly changing emotions, which can blur the lines between their own emotional states and those of others.
4. Fear of Abandonment: This fear can lead to frantic efforts to avoid real or imagined abandonment, further complicating their ability to maintain healthy boundaries.

People with borderline personality disorder cannot tolerate the thought of being alone and will make frantic efforts (including making suicidal gestures and engaging in self-mutilation) to avoid abandonment or separation (whether real or imagined). Their relationships are intense and unstable; for example, a lover may be idealised early in a relationship, but then later vilified at the slightest sign she appears to no longer show interest.

These individuals have an unstable view of self and, thus, might suddenly display a shift in personal attitudes, interests, career plans, and choice of friends. For example, a law school student may, despite having invested tens of thousands of dollars toward earning a law degree and having performed well in the program, consider dropping out and pursuing a career in another field. People with borderline personality disorder may be highly impulsive and may engage in reckless and self-destructive behaviours such as excessive gambling, spending money irresponsibly, substance abuse, engaging in unsafe sex, and reckless driving. They sometimes show intense and inappropriate anger that they have difficulty controlling, and they can be moody, sarcastic, bitter, and verbally abusive.

The prevalence of borderline personality disorder in the US population is estimated to be around 1.4% (Lezenweger et al., 2007), but the rates are higher among those who use mental health services; approximately 10% of mental health outpatients and 20% of psychiatric inpatients meet the criteria for diagnosis (APA, 2013). Additionally, borderline personality disorder is comorbid with anxiety, mood, and substance use disorders (Lezenweger et al., 2007).

>Biological Basis for Borderline Personality Disorder

Genetic factors appear to be important in the development of borderline personality disorder. For example, core personality traits that characterise this disorder, such as impulsivity and emotional instability, show a high degree of heritability (Livesley, 2008). Also, the rates of borderline personality disorder among relatives of people with this disorder have been found to be as high as 24.9% (White, Gunderson, Zanarani, & Hudson, 2003).

Individuals with borderline personality disorder report experiencing childhood physical, sexual, and/or emotional abuse at rates far greater than those observed in the general population (Afifi et al., 2010), indicating that environmental factors are also crucial. These findings would suggest that borderline personality disorder may be determined by an interaction between genetic factors and adverse environmental experiences. Consistent with this hypothesis, one study found that the highest rates of borderline personality disorder were among individuals with a borderline temperament (characterised by high novelty-seeking and high harm-avoidance) and those who experienced childhood abuse and/or neglect (Joyce et al., 2003).

Antisocial Personality Disorder

Most human beings live in accordance with a moral compass, a sense of right and wrong. Most individuals learn at a very young age that there are certain things that should not be done. We learn that we should not lie or cheat. We are taught that it is wrong to take things that do not belong to us, and that it is wrong to exploit others for personal gain. We also learn the importance of living up to our responsibilities, of doing what we say we will do. People with antisocial personality disorder, however, do not seem to have a moral compass. These individuals act as though they neither have a sense of nor care about right or wrong. Not surprisingly, these people represent a serious problem for others and for society in general.

According to the DSM-5, the individual with antisocial personality disorder shows no regard at all for other people’s rights or feelings. This lack of regard is exhibited a number of ways and can include repeatedly performing illegal acts, lying to or conning others, impulsivity and recklessness, irritability and aggressiveness toward others, and failure to act in a responsible way (e.g., leaving debts unpaid) (APA, 2013). The worst part about antisocial personality disorder, however, is that people with this disorder have no remorse over their misdeeds; these people will hurt, manipulate, exploit, and abuse others and not feel any guilt. Signs of this disorder can emerge early in life; however, a person must be at least 18 years old to be diagnosed with antisocial personality disorder.

People with antisocial personality disorder seem to view the world as self-serving and unkind. They seem to think that they should use whatever means necessary to get by in life. They tend to view others not as living, thinking, feeling beings, but rather as pawns to be used or abused for a specific purpose. They often have an over-inflated sense of themselves and can appear extremely arrogant. They frequently display superficial charm; for example, without really meaning it they might say exactly what they think another person wants to hear. They lack empathy — they are incapable of understanding the emotional point-of-view of others. People with this disorder may become involved in illegal enterprises, show cruelty toward others, leave their jobs with no plans to obtain another job, have multiple sexual partners, repeatedly get into fights with others, and show reckless disregard for themselves and others (e.g., repeated arrests for driving while intoxicated) (APA, 2013).

The DSM-5 has included an alternative model for conceptualising personality disorders based on the traits identified in the Five Factor Model of personality. This model addresses the level of personality functioning such as impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning. In the case of antisocial personality disorder, the DSM-5 identifies the predominant traits of antagonism (such as disregard for others’ needs, manipulative or deceitful behaviour) and disinhibition (characterised by impulsivity, irresponsibility, and risk-taking) (Harwood, Schade, Krueger, Wright, & Markon, 2012). A psychopathology specifier is also included that emphasises traits such as attention-seeking and low anxiousness (lack of concern about negative consequences for risky or harmful behaviour) (Crego & Widiger, 2014).

Risk Factors for Antisocial Personality Disorder

Antisocial personality disorder is observed in about 3.6% of the population. The disorder is much more common among males, with a 3 to 1 ratio of men to women; it is more likely to occur in men who are younger, widowed, separated, divorced, of lower socioeconomic status, who live in urban areas, and who live in the western United States (Compton, Conway, Stinson, Colliver, & Grant, 2005). Compared to men with antisocial personality disorder, women with the disorder are more likely to have experienced emotional neglect and sexual abuse during childhood, and they are more likely to have had parents who abused substances and who engaged in antisocial behaviours themselves (Alegria et al., 2013).

Table PD.3 shows some of the differences in the specific types of antisocial behaviours that men and women with antisocial personality disorder exhibit (Alegria et al., 2013).

Family, twin, and adoption studies suggest that both genetic and environmental factors influence the development of antisocial personality disorder, as well as general antisocial behaviour (criminality, violence, aggressiveness) (Baker, Bezdjian, & Raine, 2006). Personality and temperament dimensions that are related to this disorder, including fearlessness, impulsive antisociality, and callousness, have a substantial genetic influence (Livesley & Jang, 2008).
Adoption studies clearly demonstrate that the development of antisocial behaviour is determined by the interaction of genetic factors and adverse environmental circumstances (Rhee & Waldman, 2002). For example, one investigation found that adoptees of biological parents with antisocial personality disorder were more likely to exhibit adolescent and adult antisocial behaviours if they were raised in adverse adoptive family environments (e.g., adoptive parents had marital problems, were divorced, used drugs, and had legal problems) than if they were raised in a more normal adoptive environment (Cadoret, Yates, Ed, Woodworth, & Stewart, 1995).

Researchers who are interested in the importance of environment in the development of antisocial personality disorder have directed their attention to such factors as the community, the structure and functioning of the family, and peer groups. Each of these factors influences the likelihood of antisocial behaviour. One longitudinal investigation of more than 800 Seattle-area youth measured risk factors for violence at 10, 14, 16, and 18 years of age (Herrenkohl et al., 2000). The risk factors examined included those involving the family, peers, and community. A portion of the findings from this study are provided in Figure PD.23.

Those with antisocial tendencies do not seem to experience emotions the way most other people do. These individuals fail to show fear in response to environment cues that signal punishment, pain, or noxious stimulation. For instance, they show less skin conductance (sweatiness on hands) in anticipation of electric shock than do people without antisocial tendencies (Hare, 1965). Skin conductance is controlled by the sympathetic nervous system and is used to assess autonomic nervous system functioning. When the sympathetic nervous system is active, people become aroused and anxious, and sweat gland activity increases. Thus, increased sweat gland activity, as assessed through skin conductance, is taken as a sign of arousal or anxiety. For those with antisocial personality disorder, a lack of skin conductance may indicate the presence of characteristics such as emotional deficits and impulsivity that underlie the propensity for antisocial behaviour and negative social relationships (Fung et al., 2005).

Another example showing that those with antisocial personality disorder fail to respond to environmental cues comes from a recent study by Stuppy-Sullivan and Baskin-Sommers (2019). The researchers studied cognitive and reward factors associated with antisocial personality disorder dysfunction in 119 incarcerated males. Each subject was administered three tasks targeting different aspects of cognition and reward. High-magnitude rewards tended to impair perception in those with antisocial personality disorder, worsened executive function when they were consciously aware of the high rewards, and worsened inhibition when the tasks placed high demand on working memory.

Watch this video: Tricky Topics: Mood Disorders vs. Personality Disorders (9 minutes)

“Tricky Topics: Mood Disorders vs. Personality Disorders” video by FirstYearPsych Dalhousie is licensed under the Standard YouTube licence.

Here is the Tricky Topics: Neuronal Structure transcript.

Image Attributions

Figure PD.23. Figure 15.20 as found in Psychology 2e by OpenStax is licensed under a CC BY 4.0 License.