Personality Disorders and the Five-Factor Model of Personality

475 Pages·2002·39.25 MB·English

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

Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
1 Introduction: Personality Disorders and the Five-Factor Model of Personality . . 3
Paul T. Costa, Jr:, and Thomas A. Widiger
PART I : 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. Tmll and Robert R. McCrae
5 Five-Factor Model Personality Disorder Research . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Thomas A. Widiger and Paul T. Costa, Jr:
6 A Description of the DSM-IV Personality Disorders With the Five-Factor
Model of Personality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Thomas A. Widigev, Timothy 1. Trull, John E Clarhin, Cynthia Sanderson,
and Paul Z Costa, Jr:
PART 11: MODELS OF PERSONALITY DIMENSIONS AND DISORDERS
7 Personality Structure and the Structure of Personality Disorders . . . . . . . . . . . . . 103
Jerry 5. Wimns and Aaron L. Pincus
8 Personality Disorder Symptomatology from the Five-Factor Model Perspective. . . 125
Lee Anna Clark, Lu Vorhies, andJoyce L. McEwen
9 Dimensions of Personality Disorder and the Five-Factor Model of Personality . . . 149
Marsha L. Schroedev,J anice A. Wormworth, and W John Livesley
10 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
11 Big Five, Alternative Five, and Seven Personality Dimensions: Validity in
Substance-Dependent Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Samuel A. Ball
12 Constellations of Dependency Within the Five-Factor Model of Personality 203
Aaron L. Pincus
13 Personality Disorders and the Five-Factor Model of Personality in Chinese
Psychiatric Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 15
Jian Yang, Xiaoyang Dai, Shuqiao Yao, Taisheng Cai, Beiling Gao,
Robert R. McCrae, and Paul 7: Costa, j r
14 Tests of General and Specific Models of Personality Disorder Configuration. . . . 223
Brian P O’Connor and Jamie A. Dyce
PART 111: PATIENT POPULATIONS AND CLINICAL CASES
15 Personality Trait Characteristics of Opioid Abusers With and Without
Comorbid Personality Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Robert K. Broonel; Chester W Schmidt, J r , and JejJrey H. Herbst
16 The NEO Personality Inventory and the Millon Clinical Multiaxial Inventory
in the Forensic Evaluation of Sex Offenders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Gregory K. Lehne
17 A Case of Borderline Personality Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Stephen Bruehl
18 Narcissism From the Perspective of the Five-Factor Model. . . . . . . . . . . . . . . . . . 293
Elizabeth M . Corbitt
19 Personality of the Psychopath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Timothy J. Harpul; Stephen D. Hart, and Robert D. Hare
20 Psychopathy From the Perspective of the Five-Factor Model of Personality . . . . 325
Donald R. Lynarn
PART IV: DIAGNOSIS AND TREATMENT USING THE FIVE-FACTOR-MODEL
21 Further Use of the NEO-PI-R Personality Dimensions in Differential
Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Cynthia Sanderson and John E Clarkin
22 Using Personality Measurements in Clinical Practice . . . . . . . . . . . . . . . . . . . . . . . 377
K. Roy MacKenzie
23 Implications of Personality Individual Differences Science for Clinical Work
on Personality Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Allan R. Harkness andJohn L. McNulty
24 Treatment of Personality Disorders From the Perspective of the
Five-Factor Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Michael H. Stone
25 A Proposal for Axis 11: Diagnosing Personality Disorders Using the
Five-Factor Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
Thomas A. Widigel; Paul 1 Costa, J r , and Robert R. McCrae
...
Vlll
Contents
APPENDIXES
A The DSM-111-R Personality Disorders and the Five-Factor Model . . . . . . . . . . . . . 457
B Personality Disorders Proposed for DSM-IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459
C The DSM-IV Personality Disorders and the Five-Factor Model . . . . . . . . . . . . . . . 461
D Description of the Revised NEO Personality Inventory (NEO-PI-R)
Facet Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463
E Diagnostic Criteria of DSM-IV-TR Axis I1 Personality Disorders . . . . . . . . . . . . . . 469
Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
About the Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493
ix
Contributors
Samuel A. Ball, Department of Psychiatv, Yale University School of Medicine,
New Haven, CT
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 Centel; 2nd Affiliated Hospital, Hunan Medical
University, Changsha, People’s Republic of China
Lee Anna Clark, Department of Psychology, University of Iowa, Iowa City
John E Clarkin, Department of Psychiatry, Cornell University Medical Centel; Ithaca, NY
Elizabeth M. Corbitt, Wright State University School of Medicine, Dayton, OH
Paul T. Costa, Jr., National Institute of Aging, National Institutes of Health, Baltimore, MD
Xiaoyang Dai, Clinical Psychologcal Research Centel; 2nd Affiliated Hospital, Hunan Medical
University, Changsha, People’s Republic of China
John M. Digman, Oregon Research Institute, Eugene, OR
Jamie A. Dyce, Department of Psychology, Concordia University of Alberta, Edmonton, Alberta,
Canada
Allen J . Frances, Department of Psychiatry and Behavioral Sciences, Duke University Medical
Centel; Durham, NC
Beiling Gao, Clinical Psychological Research Centel; 2nd Affiliated Hospital, Hunan Medical
University, Changsha, People’s Republic of China
Robert D. Hare, Department of Psychology, University of Bntish Columbia, Vancouver Bntish
Columbia Canada
Allan R. Harkness, Department o j Psychology, University of Tulsa, Tulsa, OK
Timothy J . Harpur, Department of Psychology, University of Illinois at Urbana-Champaign
xi
Contributors
Stephen D. Hart, Department of Psychology, University of 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 of Medicine, Baltimore, MD
W. John Livesley, Department of Psychiatry, University of British Columbia, Vancouver, British
Columbia, Canada
Donald R. Lynam, Department of Psychology, University of Kentucky, Lexington
K. Roy MacKenzie, Department of Psychiatry, University of British Columbia, Vancouver, British
Columbia, Canada
Robert R. McCrae, Gerontology Research Center, National Institute on Aging,
Baltimore, MD
Joyce L. McEwen, Department of Psychology, Southern Methodist University, Dallas, TX
John L. McNulty, Department of Psychology, Kent State University, Kent, OH
Brian €? O’Connor, Department of Psychology, Lakehead University, Thunder Bay,
Ontario, Canada
Aaron L. Pincus, Department of Psychology, Pennsylvania State University, University Park
Cynthia Sanderson, Department of Psychiatry, Cornell Medical College, Ithaca, NY
Chester W. Schmidt, Jr., Department of Psychiatry and Behavioral Sciences, Johns Hopkins
University School of Medicine, Baltimore, MD
Marsha L. Schroeder, Department of Psychiatry, University of British Columbia, Vancouver,
British Columbia, Canada
Michael H. Stone, Department of Psychiatry, Columbia University, New York, NY
Timothy J. Trull, Department of Psychology, University of Missouri-Columbia
Lu Vorhies, Department of Psychology, Southern Methodist University, Dallas, TX
Thomas A. Widiger, Department of Psychology, University of Kentucky, Lexington
Jerry S. Wiggins, Department of Psychology, University of British Columbia, Vancouver, British
Columbia, Canada
Janice A. Wormworth, Department of Psychiatry, University of British Columbia, Vancouvel;
British Columbia, Canada
Jian Yang, Gerontology Research Center, National Institute on Aging, Baltimore, MD
Shuqiao Yao, Clinical Psychological Research Center, 2nd Afiliated Hospital, Hunan Medical
University, Changsha, PeopleS Republic of China
xii
PERSONALITY DISORDERS
AND THE FIVE-FACTOR MODEL OF PERSONALITY
C H A P T E R1
INTRODUCTION: PERSONALITY
DISORDERS AND THE FIVE-FACTOR
MODEL OF PERSONALITY
Paul 1 Costa, J K , and Thomas A. Widiger
In the last 20 years, interest in personality disorder Trull, Hurt, Clarkin, & Frances, 1987). This comor-
research has shown substantial growth. Personality bidity is a serious problem because it suggests re-
disorders were, no doubt, catapulted into a promi- dundancy, or a lack of divergent construct validity,
nent position by the creation of a special axis, Axis for the current set of 10 diagnostic categories of
11, in the third edition of the Diagnostic and Statisti- DSM-IV-defined personality disorders. Other crucial
cal Manual of Mental Disorders (DSM-III; American problems concern the excessive comorbidity of Axis
Psychiatric Association, 19801, a multiaxial classifica- I and Axis I1 diagnoses (Docherty, Fiester, & Shea,
tion of mental disorders system. Research interest in 1986; McGlashan, 1987; Widiger & Hyler, 1987)
personality disorders can be documented by the and the general lack of evidence supporting the con-
more than 750 empirical studies that are abstracted struct validity of many of the personality disorder
in thc American Psychological Association’s PsycLIT categories.
database, covering the 5-year period from January Problems with the official DSM-classification
1987 to June 1992. Since the first edition of this scheme for personality disorders continues to receive
book (Costa & Widiger, 19941, not only has there the attention of researchers, reviewers, and editors
been a steady flow of empirical research dealing alike. In a Special Feature section of the Spring
with personality disorders, but there have also been 2000 issue of the Journal qf Personality Disorders, ed-
important theoretical and empirical developments, itor John Livesley boldly stated that “problems with
which are pointed out later in this introductory the DSM model are all too obvious” (p. 2). These
chapter to the second edition of Personality Disorders “obvious problems” concern the limited clinical util-
and thc Five-Factor Model of Personality. ity of the categories; the diagnostic constructs that
This large and growing literature on personality clinicians find useful and the conditions they treat
disorders should not obscure the fact that there are are not included in the system. Personality disorder
serious theoretical and methodological problems not otherwise specified is often the most frequent
with the whole DSM personality disorder diagnostic diagnosis, suggesting that the existing diagnostic cat-
enterprise. Officially, the diagnostic criteria sets of egories are inadequate in their coverage. Further-
the fourth edition of the Diagnostic and Statistical more, Livesley (2000) lamented the limited con-
Manual of Mental Disorders (DSM-IV; American Psy- struct validity of the Axis I1 system, noting that
chiatric Association, 1994) Axis I1 are supposed to “almost all empirical investigations fail to support
define or diagnose patients into mutually exclusive, DSM diagnostic concepts” (p. 2) .
categorical diagnostic entities. But as many reports The fact that personality disorder has its own
document, the average number of personality disor- axis in the multiaxial DSM system encourages clini-
der diagnoses is often greater than 4 (Skodol, Ros- cians to consider the presence of a personality disor-
nick, Kellman, Oldham, & Hyler, 1988; Widiger, der for all patients-a unique position among all
3
Costa and Widiger
other classes of mental disorders. But this prominent Pincus, 1989). But one important question was
place makes the difficulties and problems identified whether studies using the models and methods of
above more acute. Oldham and Skodol (2000) normal personality research could shed light on psy-
noted that “there is growing debate about the con- chopathological and psychiatric problems, particu-
tinued appropriateness of maintaining the personal- larly personality disorders.
ity disorders on a separate axis in future editions of “Normal” and “abnormal” psychology have tradi-
the diagnostic manual” (p. 17). But moving the per- tionally been considered separate fields, but this
sonality disorders back to Axis I (Livesley, 1998) rigid dichotomy has never made sense to trait psy-
would do more than just reduce their salience. As chologists. Trait psychologists know that individual
Millon and Frances (1987) eloquently stated in the differences in most characteristics are continuously
initial issue of the Journal of Personality Disorders, distributed. It therefore seems reasonable to hypoth-
esize that different forms of psychopathology might
more relevant to this partitioning decision
be related to normal variations in basic personality
was the assertion that personality traits
dispositions.
and disorders can serve as u dynamic sub-
Considerable evidence in support of this hypoth-
strate from which clinicians can better
esis is provided by results of analyses relating mea-
grasp the signijcance and meaning of their
sures of personality to measures of psychopathology
patients transient and florid disorders. In
in normal and clinical samples. Several studies (e.g.,
the DSM-111 then, personality not only at-
Costa & McCrae, 1990; Morey, 1986; Trull, 1992)
tained a nosological status of prominence
show general parallels between psychopathological
in its own right but wus assigned a contex-
and normal personality dimensions. In many of the
tual role that made it fundamental to the
chapters in this book, authors explore ways in
understanding and interpretation of other
which normal personality dimensions can illuminate
pathologies. (p. ii)
clinical constructs. We hoped that the first edition of
How can the difficulties be constructively addressed the book would help promote further research and
and solved without seeming to abandon the impor- facilitate integration of research on personality disor-
tance of personality traits and disorders by collaps- ders with decades of research on normal personality
ing the distinction between Axis I and II? structure and measurement. As many of the new
Many of the problems of DSM-IV might be re- chapters attest (e.g., chapters 5 , 11-14, 20>, there
solved by using continuous dimensions instead of has indeed been a substantial amount of new and
discrete categories. Dimensional alternatives have productive FFM personality disorder research.
been frequently proposed, but until recently, there From the time this book was first contemplated,
was no consensus on which personality dimensional interest in and efforts to apply the FFM to a variety
model should be used. The five-factor model (FFM; of disorders and populations has moved at a rapid
Digman, 1990; McCrae, 1992) is a taxonomy of per- pace. We originally limited our focus to diagnostic
sonality traits in terms of five broad dimensions (the issues, but the scope has now been enlarged to in-
“Big Five”): Neuroticism (N), Extraversion (E), clude treatment implications. A major addition to
Openness to Experience (O)A,g reeableness (A), and the second edition is a specific 4-step process for
Conscientiousness (C). An emergent and still- making diagnoses using the FFM (see Widiger,
growing consensus on the FFM suggests that this is Costa, & McCrae, chapter 25, this volume).
a comprehensive classification of personality dimen- We hope that readers will want to sample di-
sions that may be a conceptually useful framework rectly the fruits of the field, as it were. One aim of
for understanding personality disorders. this book is to promote greater interest and research
By the early 1990s, there had been considerable between the FFM and personality disorders. The
research confirming the FFM and demonstrating the book is intended to give its readers a glimpse of the
value of studying individual differences in personal- application of the FFM for the diagnosis and treat-
ity (e.g., Digman, 1990; McCrae, 1992; Wiggins & ment of personality disorders.
4
lnkoduction
BACKGROUND OF THE Clark, and Harkness model is not an alternative to
FIVE-FACTOR MODEL the FFM; it is simply the FFM without the dimen-
sion of 0.H owever, Cloninger (1987), a psychia-
The FFM is a hierarchical model of the structure of
trist, advanced a neuroadaptive-based personality
personality traits. Personality traits are often defined
model with originally three dimensions that is both
as enduring “dimensions of individual differences in
similar to and different from Eysencks and Tellegen’s
tendencies to show consistent patterns of thoughts,
three-factor models. In Cloninger’s model, N (or
feelings, and actions” (McCrae & Costa, 1990, p.
NA) is called Harm Avoidance; Novelty Seeking is
23). Traits reflect relatively enduring dispositions
largely low C; and the third dimension, Reward De-
and are distinguished from states or moods, which
pendence, has no simple and direct correspondence
are more transient. The FFM had its origins in anal-
to any of the five established dimensions of the FFM
yses of trait-descriptive terms in the natural lan-
because it loads on three or four of the five dimen-
guage. John, Angleitner, and Ostendorf (1988) gave
sions (Costa & McCrae, 1993; Herbst, Zonderman,
an excellent account of this important line of re-
McCrae, & Costa, 2000). Cloninger’s original instru-
search, and the contributions of Tupes and Christal
ment, the Tridimensional Personality Questionnaire,
(1961), Norman (1963), Goldberg (1982), and Bor-
has been revised substantially by splitting off the 8-
kenau and Ostendorf (1990) are deservedly recog-
item subscale, RD2, into a persistence temperament
nized by the field of FFM researchers.
dimension to yield four temperaments and three so-
But most research and practice of personality as-
called character dimensions have also been added,
sessment has been based on questionnaires. As Wig-
leading to a seven-dimensional model (Cloninger,
gins (1968) wrote, the “Big Two” dimensions of N
Svrakric, & Przybeck, 1993). An important chapter
and E have been long associated with Hans Eysenck.
(14, this volume) by O’Connor and Dyce compares
Another two-dimensional model that deserves spe-
Cloninger’s seven-dimensional model with alternative
cial attention is the interpersonal circle model (i.e.,
models to identify the optimal structural representa-
the interpersonal circumplex) associated with Kiesler
tion of personality disorders.
(1983), Leary (1957), and Wiggins (1982).
Other dimensional models that contain more fac-
Uith the addition of Psychoticism (P), Eysencks
tors than the familiar five are seen in the 10 factors
(Eysenck & Eysenck, 1975) P, E, N model is one of
of Guilford, Zimmerman, and Guilfordk (1976)
several competing three-factor models. Tellegen
Guilford-Zimmerman Temperament Survey. Of
(1985) advanced an alternative three-factor model
course, Cattell’s (Cattell, Eber, & Tatsuoka, 1970)
that substitutes Constraint for F! It should be noted
Sixteen Personality Factor Questionnaire represents
that in Tellegen’s model both N and E are construed
Cattell’s model of 16 primary personality traits.
as the dimensions Negative Affectivity (NA) and
All of these systems are interesting, and many are
Positive Affectivity, respectively. Watson, Clark, and
valuable in understanding personality disorders, es-
Harkness (1994) proffered a four-factor model based
pecially the interpersonal circumplex. But mounting
on the literature relating personality disorders to the
evidence suggests that all or nearly all of these mod-
FFM, where the current conceptualizations of the 10 els can be either subsumed by the FFM or inter-
personality disorder categories largely ignore 0. preted in terms of it. Postulated dimensions beyond
Man): of the personality disorder diagnostic criteria the Big Five, such as the Guilford-Zimmerman and
fail to adequately represent 0-related features, such Cattell models, for example, are generally regarded
as restricted emotional expression or intolerance of as tapping trait dimensions at a lower level in the
differing views. But even if the personality disorders hierarchy.
were completely unrelated to 0, which is probably The consensus currently is that at the second-
not the case, one would not “downsize” the person- order level, the five broad dimensions of N , E, 0, A,
ality taxonomy to four dimensions because of its and C are the basic dimensions of personality. For
currently inadequate representation in the DSM. Un- the sake of this text, we adopt the position articu-
like Eysencks or Tellegen’s models, the Watson, lated by McCrae and John (1992) that it is fruitful
5