Antisocial, Narcissistic, and Borderline Personality Disorders

A New Conceptualization of Development, Reinforcement, Expression, and Treatment

Daniel J. Fox

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9780367218058
• eBook ISBN: 9780429561160
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

This book provides a framework for scholars and clinicians to develop a comprehensive and dynamic understanding of antisocial, narcissistic, and borderline personality disorders, by seeing personality as a dual, as opposed to a singular, construct.

Converging the two separate research and clinical diagnostic systems into a wholistic model designed to reach reliable and valid diagnostic conclusions, the text examines adaptive and maladaptive personality development and expression, while addressing the interpersonal system that keeps the pathology from extinguishing. Each chapter will discuss core and surface content, origin and symptom manifestation, system and pathology perpetuation, and online behavior expression, concluding with practical guidance on treatment success and effective approaches.

Seasoned and tyro researchers and clinicians will be challenged to explore the utility of the DSM-5 alternative model of personality disorders and apply it to further the understanding of these complex, and often destructive, disorders.

Chapter 1

Introduction

Personality and Its Structure

Personality is an internal, psychological construct that determines how an individual views and makes sense of events, interacts with others, and creates expectations as to how the world functions. The complexity of this construct has led to many different approaches and conceptualizations of personality, leaving many challenged and confused about its make-up and influence on the individual as a whole (Allport, 1937).

Out of the attempt to understand and lessen this confusion, researchers attempted to identify general personality traits which, when pulled together, create a personality profile. This profile is designed to assist others in understanding an individual’s view of self and the world and in predicting how an individual will respond when confronted with various situations and stressors (Allport, 1968; Costa & McCrae, 1992; Mischel, 2004).

Research on personality traits has continued concurrent to the search for the function, structure, and organization of personality, in order to explain one’s distinctiveness from others, one’s view of the world, and one’s variability in behavioral response often seen in practice and “the real world” (Cervone, 2004; Mischel, 2004). These bifurcated endeavors created what is often called the research-to-practice gap, or a notable disparity between the findings of empirical research and implementation in clinical or daily practice. These discrepancies are evident in the fields of psychology, personality, medicine, and countless others that examine individual differences in the makeup of how a person views the self, others, and situations (DeAngelis, 2010; Kessler, 2008; Mallonee, Fowler, & Istre, 2006). Although they share a common goal, the roads of research and practice continue to lack the overlap needed to draw a deeper and greater understanding of the study and expression of human function and response. Bridging the research-to-practice gap will lessen the confusion inherent in the understanding of personality and its aberration, thus moving the fields of personality research and practice forward, while enhancing its applicability.

By pulling together these critical factors into a single conceptualization that captures the structure of personality and its impact on the individual, researchers and clinicians will be better equipped to address the research-to-practice gap. This book aims to provide this singular and comprehensive framework for a deeper and clearer understanding of aberrant and unimpaired or “normal” personality that will advance research, practice, and applicability.

Core and Surface Structure of Personality

The first step to narrowing the research-to-practice gap is to explore the architecture of personality and to recognize its core and surface structure. Extant theories of personality structure have circuitously touched on personality architecture but failed to apply it more comprehensively to personality. Beck’s model of cognition (1995, 1999) illustrates this very point. The model identifies three levels: core beliefs, intermediate beliefs, and automatic thoughts and images. Core beliefs are theorized to be entrenched, or deep and influential, in how an individual interprets, appraises, and responds to situations. Beck (1995) describes how intermediate beliefs influence unspoken attitudes, rules, expectations, or assumptions, and automatic thoughts or images are at a “superficial” or top level, reflecting how the individual verbally responds or thinks about a particular situation. These three components are theoretically structural, in that core beliefs comprise the foundation, intermediate beliefs are at the second level, and automatic thoughts and images are the top, or surface, level.

Beck is not alone in his structural conceptualization of internal mechanisms that influence an individual’s response. Mischel (2004) describes the contents of memory and a “motivated meaning system” (p. 9) that guides the individual’s interpretations of situations, which impacts the person–situation interaction in one’s environment.

Beck and Mischel’s theories are sound, but they only address part of the aspect of the inner workings of personality. Whereas Beck (1995) sees beliefs and thoughts and Mischel (2004) sees memory and meaning as a means to examine personality to explain behavior, it is the combination of these two approaches that provides a more unified, but still incomplete, framework. While these conceptualizations certainly help to explain how past experiences, thoughts, and cognitive appraisal or meaning influence how someone sees the self, others, and situations and drive behavior, the critical component of emotions is left out.

Akin to cognitive theories, emotions factor into the structure of personality at all levels and have thus been the subject of much study in personality research. In particular, researchers have focused heavily on the stability of emotions across environments and experiences, which adds to the understanding and predictability of a behavioral response (DeYoung, Peterson, & Higgins, 2002; Friedman & Schustack, 2016). Much of this research has been examined from a standpoint of compartmentalization – emotions as one component and beliefs, thoughts, memories as another.

Attempts to reconcile this compartmentalization have been made using the trait approach, such as the well-known five-factor model (FFM; Block, 1995; Costa & McCrae, 1995; Paunonen & Jackson, 2000). The FFM, which includes openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism, is the almost universal method most often applied to do this. Trait descriptions of each of the five factors are listed in Table 1.1.

Table 1.1 The Five-Factor Model

Openness to Experience	Imaginative, Creative, Unique, and Curious
Conscientiousness	Hard-working, perseverant, well-organized, and punctual.
Extraversion	Talkative, active, affectionate, and optimistic.
Agreeableness	Trusting, lenient, soft-hearted, and good-natured.
Neuroticism	Worry-prone, self-conscious, feels inadequate, and hypochondriacal.

The FFM has been applied to the conceptualization of individual differences in human functioning and provides a valuable framework for the understanding of personality disorders and their structure (Costa & Widiger, 1994; Trull & Widiger, 2013).

Disordered Personality and Its Structure

Before delving into the approach toward a structure of personality pathology discussed in this text, it is first necessary to contextualize the history of personality disorder, as characterized in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Readers interested in a more comprehensive history of the development of the DSM, from its inception to the present, are referred to Blashfield et al. (2014).

When the first edition of the DSM (American Psychiatric Association (APA), 1952) was published, there were five classification systems for psychiatric conditions in use in the United States. This variability in approach, conceptualization, and use prompted the APA to create a unified and conclusive diagnostic system (Fischer, 2012). This first edition defined personality disorder as “a behavioral reaction… [that] may be defined as one in which the personality, in its struggle for adjustment to internal and external stresses, utilizes primarily a pattern of action or behavior” (p. 13). According to this definition, a disordered personality is characterized by behavioral responses driven by internal and external factors. This definition, even back in 1952, loosely identified the structural component of personality via “internal and external stresses,” but, without deeper definition, added complexity and confusion in its understanding and application.

In 1968, the DSM-II (APA, 1968) was published with the aim of consolidating the criteria between the DSM and the World Health Organization’s International Classification of Disease (ICD), which was in its eighth edition at the time (Fischer, 2012). In this edition of the DSM, personality disorders have their own section titled: Personality Disorders and Certain Other Non-Psychotic Mental Disorders. Definitionally, personality disorders in the DSM-II were “characterized by deeply ingrained maladaptive patterns of behavior that are perceptibly different in quality from psychotic and neurotic symptoms” (pp. 41–42). This definition was changed markedly from the first DSM, moving away from a structural perspective, while recognizing the developmental aspect of personality, noting the degree to which personality disorders are “life-long patterns, often recognizable by the time of adolescence or earlier.”

The DSM-III (APA, 1980) was published in 1980, and the criteria were revamped in many ways under the direction of Robert Spitzer, criteria prominent researcher from the New York State Psychiatric Institute (Fischer, 2012). The DSM-III was a major departure from the previous versions, leading it to be highly controversial. One such critique was that the DSM-III nebulously defined the concept of “dysfunction” bringing into question the entire approach of the manual (Wakefield, 1992, 1999). Notably, the DSM-III moved in the direction of empirically based and operationally defined mental disorders, which set the foundation for modern approaches to diagnosis (Fischer, 2012; Mayes & Horowitz, 2005). This edition also saw the birth of the multiaxial system, which was composed of five axes, listed as follows:

Axis I: Clinical Disorders

Axis II: Personality Disorders or Mental Retardation

Axis III: Medical or Physical Conditions

Axis IV: Contributing Environmental or Psychosocial Factors

Axis V: Global Assessment of Functioning.

The expectation was that every client would be assessed on the five axes, which would provide a greater understanding and recognition of the pathology present in the individual. In regard to personality disorders, the multiaxial system would presumably increase the accuracy of diagnosis, as research had identified that “preexisting personality disturbance” increase...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of Tables
• List of Figures
• Acknowledgements
• About the Author
• 1 Introduction
• 2 Antisocial Personality Disorder
• 3 Narcissistic Personality Disorder
• 4 Borderline Personality Disorder
• References
• Index