Personality Disorders and the Five-Factor Model of Personality

475 Pages·1974·14.07 MB·English

by  Thomas A. Widiger, Paul T., Jr. Costa

Contents

Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 Introduction: Personality Disorders and the Five-Factor Model of Personality . .

Paul

PART

T

xi

3

Costa, Jr., and Thomas A Widiger

l: CONCEPTUAL BACKGROUND

2 Historical Antecedents of the Five-Factor ModeL . . . . . . . . . . . . . . . . . . . . . . . . . .

17

John M. Digman

3 Toward a Dimensional Model for the Personality Disorders . . . . . . . . . . . . . . . . .

23

Thomas A Widiger and Allen J Frances

4

A Five-Factor Perspective on Personality Disorder Research . . . . . . . . . . . . . . . . .

45

Timothy J Trull and Robert R. McCrae

5

6

Five-Factor Model Personality Disorder Research . . . . . . . . . . . . . . . . . . . . . . . . . .

59

Thomas A. Widiger and Paul T Costa, Jr.
A Description of the DSM-IV Personality Disorders With the Five-Factor

Model of Personality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

89

Thomas A Widiger, Timothy J Trull, John F. Clarkin, Cynthia Sanderson,
and Paul T Costa, Jr.

PART II: MODELS OF PERSONALITY DIMENSIONS AND DISORDERS

7

Personality Structure and the Structure of Personality Disorders . . . . . . . . . . . . . 1 03

Jerry S. Wiggins and Aaron L. Pincus

8

Personality Disorder Symptomatology from the Five-Factor Model Perspective. . . 1 2 5

Lee Anna Clark, Lu Vorhies, and Joyce L. McEwen

9

Dimensions of Personality Disorder and the Five-Factor Model of Personality . . . 1 49

Marsha L. Schroeder, Janice A. Wormworth, and W John Livesley

1 0

Two Approaches to Identifying the Dimensions of Personality Disorder:

Convergence on the Five-Factor Model . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . .. 161

Lee Anna Clark and W John Livesley

vii
Contents

1 1

Big Five, Alternative Five, and Seven Personality Dimensions: Validity in

Substance-Dependent Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '

1 77

Samuel A. Ball

12 Constellations of Dependency Within the Five-Factor Model of Personality

203

Aaron L. Pincus

1 3

Personality Disorders and the Five-Factor Model of Personality i n Chinese
Psychiatric Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 5

Jian Yang, Xiaoyang Dai, Shuqiao Yao, Taisheng Cai, Beiling Gao,
Robert R. McCrae, and Paul T Costa, Jr.

1 4

Tests of General and Specific Models of Personality Disorder Configuration . . . , 223

Brian P. O'Connor and Jamie A. Dyce

PART III: PATIENT POPULATIONS AND CLINICAL CASES

1 5 Personality Trait Characteristics o f Opioid Abusers With and Without
Comorbid Personality Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,
Robert K. Brooner, Chester W Schmidt, Jr., and Jeffrey H. Herbst 249
1 6 The NEO Personality Inventory and the Millon Clinical Multiaxial Inventory
in the Forensic Evaluation of Sex Offenders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,
Gregory K. Lehne 269

1 7

A Case of Borderline Personality Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 283

Stephen Bruehl

1 8

Narcissism From the Perspective of the Five-Factor Model . . . . . . . . . . . . . . . . . . 293

Elizabeth M. Corbitt

1 9

Personality of the Psychopath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 299

Timothy]. Harpur, Stephen D. Hart, and Robert D. Hare

20

Psychopathy From the Perspective of the Five-Factor Model of Personality . . . , 325

Donald R. Lynam

PART IV: DIAGNOSIS AND TREATMENT USING THE FIVE-FACTOR-MODEL

2 1

22

Further Use of the NEO-PI-R Personality Dimensions in Differential
Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,
Cynthia Sanderson and John F. Clarkin

Using Personality Measurements in Clinical Practice

K.

23

. . .

3 5 1

. . . . . . . . . . . . . . . . . . . , 377

Roy MacKenzie

Implications of Personality Individual Differences Science for Clinical Work
on Personality Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 391

Allan R. Harkness and John L. McNulty

24

Treatment of Personality Disorders From the Perspective of the
Five-Factor Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . .

405
. . ,

Michael H. Stone

2 5

A Proposal for Axis I I : Diagnosing Personality Disorders Using the
Five-Factor Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 43 1

Thomas A. Widiger, Paul

viii

T Costa, Jr., and Robert R. McCrae
ConlenlS

APPENDIXES

A

The DSM-III-R Personality Disorders and the Five-Factor Model . . . . . . . . . . . . . 457

459

the Five-Factor Model . . . . . . . . . . . . . . . 461

B Personality Disorders Proposed for DSM-IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C The DSM-IV Personality Disorders and
D Description of the Revised NEO Personality Inventory (NEO-PI-R)

Facet Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463

E

Diagnostic Criteria of DSM-IV-TR Axis I I Personality Disorders . . . . . . . . . . . . .

469

Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475

Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
About the Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493

ix
Contributors

Samuel A. Ball, Department of Psychiatry, Yale University School of Medicine,
New Haven, CI

Robert K. Brooner, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, MD

Stephen Bruehl, Department of Behavioral Science, University of Kentucky College of Medicine,

Lexington

Taisheng Cai, Clinical Psychological Research Center, 2nd Affiliated Hospital, Hunan Medical
University, Changsha, People's Republic of China

Lee Anna Clark,

John F. Clarkin,

Elizabeth

Paul T.

M.

Department of Psychology, University of Iowa, Iowa City

Department of Psychiatry, Cornell University Medical Center, Ithaca, NY

Corbitt,

Costa, Jr.,

Wright State University School of Medicine, Dayton, OH

National Institute of Aging, National Institutes of Health, Baltimore, MD

Xiaoyang Dai,

University,

John

M.

Clinical Psychological Research Center, 2nd Affiliated Hospital, Hunan Medical
Changsha, People's Republic of China

Digman,

Jamie A. Dyce,

Oregon Research Institute, Eugene, OR

Department of Psychology, Concordia University of Alberta, Edmonton, Alberta,

Canada

Allen J. Frances, Department of Psychiatry and Behavioral Sciences, Duke University Medical
Center, Durham, NC

Beiling Gao, Clinical Psychological Research Center, 2nd Affiliated Hospital, Hunan Medical
University, Changsha, People's Republic of China

Robert D. Hare, Department of Psychology, University of British Columbia, Vancouver, British
Columbia, Canada

Allan R. Harkness,

Timothy J. Harpur,

Department of Psychology, University of Iulsa, Iulsa, OK

Department of Psychology, University of Illinois at Urbana-Champaign

xi
C o n t ribu t o rs

Stephen D. Hart, Department oj Psychology, University oj British Columbia, Vancouver, British
Columbia, Canada

Jeffrey H. Herbst, Gerontology Research Center, National Institute on Aging, Baltimore, MD

Gregory K. Lehne, Johns Hopkins University School oj Medicine, Baltimore, MD

W John Livesley, Department oj Psychiatry, University oj British Columbia, Vancouver, British
Columbia, Canada

Donald R. Lynam, Department oj Psychology, University oj Kentucky, Lexington

K. Roy MacKenzie, Department oj Psychiatry, University oj British Columbia, Vancouver, British

Columbia, Canada

Robert R. McCrae, Gerontology Research Center, National Institute on Aging,

Baltimore, MD

Joyce 1. McEwen, Department oj Psychology, Southern Methodist University, Dallas, TX

John 1. McNulty, Department oj Psychology, Kent State University, Kent, OH

Brian P. O'Connor, Department oj Psychology, Lakehead University, Thunder Bay,

Ontario, Canada

Aaron 1. Pincus, Department oj Psychology, Pennsylvania State University, University Park

Cynthia Sanderson, Department oj Psychiatry, Cornell Medical College, Ithaca, NY

Chester W Schmidt, Jr., Department oj Psychiatry and Behavioral Sciences, Johns Hopkins
University School oj Medicine, Baltimore, MD

Marsha 1. Schroeder, Department oj Psychiatry, University oj British Columbia, Vancouver,
British Columbia, Canada

Michael H. Stone,

Timothy]. Trull,

Department oj Psychiatry, Columbia University, New York, NY

Department oj Psychology, University oj Missouri-Columbia

Lu Vorhies, Department oj Psychology, Southern Methodist University, Dallas, TX

Thomas A. Widiger, Department oj Psychology, University oj Kentucky, Lexington

Jerry S. Wiggins, Department oj Psychology, University oj British Columbia, Vancouver, British
Columbia, Canada

Janice A. Wormworth, Department oj Psychiatry, University oj British Columbia, Vancouver,
British Columbia, Canada

Jian Yang, Gerontology Research Center, National Institute on Aging, Baltimore, MD

Shuqiao Yao, Clinical Psychological Research Center, 2nd Affiliated Hospital, Hunan Medical
University, Changsha, People's Republic oj China

xii
PERSONALITY DISORDERS

AND THE FIVE-FACTOR MODEL OF PERSONALITY
C H A P T E R 1

INTRODUCTION: PERSONALITY
DISORDERS AND THE FIVE-FACTOR
MODEL OF PERSONALITY

Paul T Costa, jr., and Thomas A. Widiger

In the last 20 years, interest in personality disorder
research has shown substantial growth. Personality

disorders were, no doubt, catapulted into a prominent position by the creation of a special axis, Axis

II, in the third edition of the Diagnostic and Statistical Manual oj Mental Disorders (DSM-III; American

Psychiatric Association, 1 980), a multiaxial classification of mental disorders system. Research interest in
personality disorders can be documented by the
more than 750 empirical studies that are abstracted

in the American Psychological Association's PsycLIT
database, covering the 5-year period from January
1987 to June 1992. Since the first edition of this
book (Costa &: Widiger, 1 994), not only has there
been a steady flow of empirical research dealing
with personality disorders, but there have also been
important theoretical and empirical developments,
which are pointed out later in this introductory
chapter to the second edition of Personality Disorders
and the Five-Factor Model oj Personality.

This large and growing literature on personality
disorders should not obscure the fact that there are
serious theoretical and methodological problems
with the whole DSM personality disorder diagnostic

enterprise. Officially, the diagnostic criteria sets of
the fourth edition of the Diagnostic and Statistical
Manual oj Mental Disorders (DSM-IV; American Psy­

chiatric Association, 1 994) Axis II are supposed to
define or diagnose patients into mutually exclusive,
categorical diagnostic entities. But as many reports
document, the average number of personality disorder diagnoses is often greater than 4 (Skodol, Rosnick, Kellman, Oldham, &: Hyler, 1 988; Widiger,

Trull, Hurt, Clarkin, &: Frances, 1 987). This comorbidity is a serious problem because it suggests redundancy, or a lack of divergent construct validity,
for the current set of 1 0 diagnostic categories of
DSM-IV-defined personality disorders. Other crucial
problems concern the excessive comorbidity of Axis
I and Axis II diagnoses (Docherty, Fiester, &: Shea,

1986; McGlashan, 1987; Widiger &: Hyler, 1 987)
and the general lack of evidence supporting the con­

struct validity of many of the personality disorder
categories.
Problems with the official DSM-classification
scheme for personality disorders continues to receive
the attention of researchers, reviewers, and editors
alike. In a Special Feature section of the Spring
2000 issue of the Journal of Personality Disorders, ed­

itor John livesley boldly stated that "problems with
the DSM model are all too obvious" (p. 2). These
"obvious problems" concern the limited clinical utility of the categories; the diagnostic constructs that

clinicians find useful and the conditions they treat
are not included in the system. Personality disorder
not otherwise speCified is often the most frequent
diagnosis, suggesting that the existing diagnostic categories are inadequate in their coverage. Furthermore, livesley (2000) lamented the limited construct validity of the Axis II system, noting that
"almost all empirical investigations fail to support

DSM diagnostic concepts" (p. 2).
The fact that personality disorder has its own
axis in the multiaxial DSM system encourages clinicians to consider the presence of a personality disorder for all patients-a unique position among all

3
Costa and Widiger

other classes of mental disorders. But this prominent
place makes the difficulties and problems identified

above more acute. Oldham and Skodol (2000)
noted that "there is growing debate about the continued appropriateness of maintaining the personality disorders on a separate axis in future editions of
the diagnostic manual" (p. 1 7) . But moving the personality disorders back to Axis I (Lives ley, 1 998)
would do more than just reduce their salience. As

Millon and Frances ( 1 987) eloquently stated in the

initial issue of the Journal of Personality Disorders,

more relevant to this partitioning decision
was the assertion that personality traits
and disorders can serve as a dynamic substrate from which clinicians can better
grasp the significance and meaning of their
patients transient and florid disorders. In
the DSM-III then, personality not only attained a nosological status of prominence
in its own right but was assigned a contextual role that made it fundamental to the
understanding and interpretation of other
pathologies. (p. ii)

How can the difficulties be constructively addressed
and solved without seeming to abandon the i mportance of personality traits and disorders by collapsing the distinction between Axis I and m
Many of the problems of DSM-IV might be re­

solved by using continuous dimensions instead of
discrete categories. Dimensional alternatives have
been frequently proposed, but until recently, there

was no consensus on which personality dimensional
model should be used. The five-factor model (FFM;
Digman, 1 990; McCrae, 1 992) is a taxonomy of personality traits in terms of five broad dimensions (the
"Big Five"): Neuroticism (N), Extraversion (E),
Openness to Experience (0), Agreeableness (A), and

Conscientiousness (C). An emergent and stillgrowing consensus on the FFM suggests that this is
a comprehensive classification of personality dimensions that may be a conceptually useful framework
for understanding personality disorders.
By the early 1 990s, there had been considerable
research confirming the FFM and demonstrating the
value of studying individual differences in personal­

ity (e.g., Digman, 1990; McCrae, 1992; W iggins &.

4

Pincus, 1 989). But one important question was
whether studies using the models and methods of
normal personality research could shed light on psychopathological and psychiatric problems, particularly personality disorders.
"Normal" and "abnormal" psychology have traditionally been considered separate fields, but this
rigid dichotomy has never made sense to trait psychologists. Trait psychologists know that individual

differences in most characteristics are continuously
distributed. It therefore seems reasonable to hypothesize that different forms of psychopathology might
be related to normal variations in basic personality
dispositions.
Considerable evidence in support of this hypoth­

esis is provided by results of analyses relating measures of personality to measures of psychopathology
in normal and clinical samples. Several studies (e.g. ,
Costa &. McCrae, 1 990; Morey, 1986; Trull, 1 992)

show general parallels between psychopathological
and normal personality dimensions. In many of the
chapters in this book, authors explore ways in
which normal personality dimensions can illuminate
clinical constructs. We hoped that the first edition of
the book would help promote further research and
facilitate integration of research on personality disorders with decades of research on normal personality
structure and measurement. As many of the new
chapters attest (e.g. , chapters 5 , 1 1 - 14, 20), there

has indeed been a substantial amount of new and
productive FFM personality disorder research.
From the time this book was first contemplated,
interest in and efforts to apply the FFM to a variety
of disorders and populations has moved at a rapid
pace. We originally limited our focus to diagnostic
issues, but the scope has now been enlarged to include treatment implications. A major addition to
the second edition is a specific 4-step process for
making diagnoses using the FFM (see Widiger,
Costa, &. McCrae, chapter 2 5 , this volume).
We hope that readers will want to sample directly the fruits of the field, as it were. One aim of
this book is to promote greater interest and research
between the FFM and personality disorders. The
book is intended to give its readers a glimpse of the
application of the FFM for the diagnosis and treat­

ment of personality disorders.
Introduction

BACKGROUND OF THE

FIVE-FACTOR MODEL

The FFM is a hierarchical model of the structure of

personality traits. Personality traits are often defined
as endu ring "di mensions of individual differences in

tendencies to show consistent patterns of thoughts,
feelings, and actions" (McCrae & Costa, 1 990, p .
23). Traits reflect relatively enduring dispositions

and are distinguished from states or moods, which
are more transient. The FFM had i ts ori gins i n anal­

yses of trait-descriptive terms in the natural language. J ohn, Angleitner, and Ostendorf (1 988) gave

an excellent account of this important line of research, and the contributions of Tupes and Christal

( 1 96 1 ) , Norman ( 1963) , Goldberg ( 1 982), and Borkenau and Ostendorf ( 1990) are deservedly recog­

nized by the field of FFM researchers.
But most research and practice of personality assessment has been based on questionnaires. As Wiggins ( 1 968) wrote, the "Big Two" dimensions of N

and E have been long associated with Hans Eysenck.

Another two-dimensional model that deserves spe­

cial attention is the interpersonal circle model (i.e.,

the i nterpersonal circumplex) associated with Kiesler
( 1 983) , Leary ( 1957), and Wiggins ( 1982) .

W ith the addition of Psychoticism (P), Eysenck's

(Eysenck & Eysenck, 1975) P, E, N model is one of
several com peting three-factor models. Tellegen

( 1 985) advanced an alternative three-factor model

that substitutes Constraint for P It should be noted

that in Tellegen's model both N and E are construed

as the dimensions Negative Affectivity (NA) and

Positive Affectivity, respectively. Watson, Clark, and
Harkness ( 1 994) proffered a four-factor model based

on th e literature relating personality disorders to the

FF M, where the current conceptualizations of the 1 0

personality disorder categories largely ignore O.
Many of the personality disorder di agnostic criteria

fail to adequately represent O-related features, such

as restricted emotional expression or intolerance of
differing views. But even if the personality disorders

were completely unrelated to 0, which is probably
not the case, one would not "downsize" the person­

ality taxonomy to four dimensions because of its
currently inadequate representation in the DSM. Un­

like Eysenck's or Tellegen's models, the Watson,

Clark, and Harkness model i s not an alternative to
the FFM; it is simply the FFM without the dimension of O. However, Cloninger ( 1 987) , a psychia­

trist, advanced a neuroadaptive-based personality
model with originally three dimensions that is both
similar to and different from Eysenck s and Tellegen's
three-factor models. In Cloninger's model, N (or
NA) is called Harm Avoidance; Novelty Seeking is
largely low C; and the third dimension, Reward Dependence, has no simple and direct correspondence

to any of the five established dimensions of the FFM
because it loads on three or four of the five dimen­

sions (Costa & McCrae, 1 993; Herbst, Zonderman,
McCrae, & Costa, 2000). Cloninger's original instru­

ment, the Tridimensional Personality Questionnaire,
has been revised substantially by splitting off the 8item subscale, RD2, into a persistence temperament
dimension to yield four temperaments and three socalled character dimensions have also been added,
leading to a seven-dimensional model (Cloninger,
Svrakric, & Przybeck, 1 993). An important chapter

(14, this volume) by O'Connor and Dyce compares
Cloninger's seven-dimensional model with alternative
models to identify the optimal structural representa­

tion of personality disorders.
Other dimensional models that contain more fac­

tors than the familiar five are seen in the 1 0 factors
of Guilford, Zimmerman, and Guilford's (1 976)
Guilford-Zimmerman Temperament Survey. Of
course, Cattell's (Cattell, Eber, & Tatsuoka, 1 970)
Sixteen Personality Factor Questionnaire represents
Cattell's model of 16 primary personality traits.

All of these systems are interesting, and many are
valuable i n und erstanding personality disorders, es­

peCially the interpersonal circumplex. But mounting
evidence suggests that all or nearly all of these mod­

els can be either subsumed by the F FM or interpreted in terms of it. Postulated dimensions beyond
the Big Five, such as the Guilford-Zimmerman and
Cattell models, for example, are generally regarded
as tapping trait dimensions at a lower level in the
hierarchy.

The consensus currently is that at the secondorder level, the fi ve broad dimensions of N, E, 0, A,
and C are the basic dimensions of personality. For
the sake of this text, we adopt the position articulated by McCrae and J ohn ( 1 992) that it is fruitful

5