Biological Psychiatry - Vol. 2

By Hugo D'Haenen; J.A. Den Boer et al. | Go to book overview

Neuropsychology of Personality Disorders

Martina M. Voglmaier


Intuitively, one might expect individuals with personality disorders to have neuropsychological deficits. The hypersensitivity of the paranoid and avoidant personalities, the rigidity of the obsessivecompulsive personality, the perceptual distortions of the schizotypal personality, and the limited social and emotional responsiveness of the schizoid personality suggest areas of deficit fascinating to the researcher interested in brain-behaviour relationships. Yet the study of neuropsychological functioning in personality disorders is in its infancy, primarily because of methodological problems associated with studying these disorders. The focus of this chapter is a general review of studies of clinical neuropsychological test performance in DSM-IV personality disorders as well as a description of the methodological problems associated with their study. Information processing, psychophysiological, and structural anatomical studies are dealt with elsewhere in this text.


Before reviewing empirical studies of neuropsychological test performance in personality-disordered individuals, a number of general methodological concerns must be addressed. Typically, in such studies, personality disorders are diagnosed by structured clinical interview, and subjects are administered a battery of neuropsychological tests measuring one or more cognitive domains, such as attention, memory, language, visuospatial perception, executive functions, and motor skills. Test performance of a group of individuals with a personality disorder of interest is then compared to that of one or more groups of subjects with either a different personality disorder, a mixed group of 'other' personality disorders, another psychiatric disorder, or no psychiatric disorder.

Research in this area is fraught with methodological difficulties. Samples differing in selection criteria, inpatient status, medications, and gender may result in inconsistent findings. Moreover, diagnosing personality disorders is a decidedly unclear science (Strack and Lorr, 1997). The clinical definition of character traits, severity, and impact on functional ability can be subjective, and whether a personality disorder can be diagnosed by self-report to an examiner in a preset period of time has been questioned (Oldham and Skodol, 1992). The DSM-IV requires a specific number of character traits to meet clinical diagnostic criteria for a personality disorder, and some studies include individuals who have fewer than the cutoff number of traits, such as those defined as having a 'probable' disorder.

Another concern is determining the specificity of any cognitive deficits given the co-occurrence of the 10 personality disorders with each other (Stuart et al., 1998), the co-morbidity of personality disorders with Axis I disorders (Oldham and Skodol, 1992), and the possibility of misdiagnosis of behavioural traits associated with neurological disorders, such as head trauma, substance abuse, and temporolimbic epilepsy (Devinsky and Najjar, 1999). For example, increased rates of depression have been associated with a number of personality disorders (Table XXVI–5.1). Even with detailed historical and diagnostic information, it could be difficult to determine whether cognitive deficits evinced by a group of subjects are related to the personality disorder under examination, to concurrent symptoms of depression, to cognitive vulnerabilities related to the predisposition to depression, or to treatments for depression. A related concern is that individuals with personality disorders may be vulnerable to neuropsychological dysfunction from secondary sources such as precursors or lifestyle behaviours associated with maladaptive personality traits. For example, risktaking behaviours, substance use, impulsivity, and aggression in antisocial personality disorder (ASPD) may increase the risk of head trauma in this population, and childhood trauma (physical, emotional, or sexual) may predispose an individual to head injury, borderline personality traits, symptoms of post-traumatic stress, and dissociative disorders (Paris, 1997).

The battery of neuropsychological tests employed in research studies is also of importance. Often, only a few tests or cognitive domains are examined, resulting in a limited view of cognitive functioning. For example, if only executive-function tasks are employed, it cannot be determined whether any weaknesses in this domain are due to a generalized deficit associated with having a psychiatric illness, or to a domain-specific deficit associated with the personality disorder being examined. Finally, there is some evidence for sex differences in cognitive functioning in some personality disorders (Voglmaier et al., submitted). Grouping males and females together in such studies may result in inconsistent findings.


General Findings

Schizotypal, paranoid, and schizoid personality disorders make up this cluster of odd and eccentric personalities. By far, the most research on cognitive functioning in this cluster has been on schizotypal personality disorder (SPD). SPD is characterized by oddities in appearance, perception, and behaviour, as well as marked discomfort in close relationships. On the hypothesis that this disorder is biologically related to schizophrenia, studies have focused on cognitive domains known to be impaired in schizophrenic subjects, that is, abstraction, attention, language, and verbal learning and memory (e.g., Gur et al., 1991; Saykin et al., 1991).


Notes for this page

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this book

This book has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this book

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Cite this page

Cited page

Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25,

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited page

Bookmark this page
Biological Psychiatry - Vol. 2
Table of contents

Table of contents



Text size Smaller Larger Reset View mode
Search within

Search within this book

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen
/ 730

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25,

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search


    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.